CTN 317: Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)

About The Study

This community-based research project aimed to develop, implement, and test the delivery of a workshop to increase health care and social service providers’ and trainees’ skills and knowledge in the HIV prevention and care cascade, as it relates to the lived experiences, priorities, and needs of trans women. The care cascade includes topics ranging from prevention resources such as PrEP and PEP, to HIV and STI testing, ART and HIV care. Ultimately, the workshop goal of the project was to motivate providers towards trans inclusion and improve their ability to provide culturally competent and gender-affirming care for this population.

About The Disease

Transgender women have much higher rates of HIV compared with cisgender adults. These high rates are the result of many forms of marginalization, including structural inequities (inadequate HIV prevention, education, resources, and services) and social inequities (poverty, racism, and stigma). Compared with cisgender people living with HIV, trans women are more likely to have lower retention in care, lower antiretroviral use and adherence, and lower rates of viral suppression.

Previous research has shown that health care and social service providers lack knowledge about trans health issues. This lack of knowledge among providers, as well as stigma and discrimination, acts as a barrier to care for trans women. However, there is a lack of high-quality, evidence-informed interventions aimed at providers to improve HIV prevention and care services for trans women, particularly in Canada.

Study Approach

This study was a collaborative, trans-led project that expanded upon existing HIV-related stigma reduction interventions and trans competency trainings to develop a workshop specific to the relationship between gender identity and HIV. Specific areas that were addressed by the workshop included trans inclusive language, human rights, social and structural inequities, transphobia, and stereotypes. Focus groups were held with trans women to gather feedback and recommendations on early forms of the Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH) Workshop.

The TEACHH Workshop was then pilot tested with care providers in Vancouver, Toronto, and Montreal. Providers in the pilot trial completed a structured interview before and after participating in the workshop; the interview was used to assess transphobia, attitudes, and trans cultural competency.

The final phase of this project involved mobilizing the knowledge gained during the study through community events, information handouts, and further implementation of the workshop.

Results

A total of 78 health care and social service providers and trainees who work with trans women living with or affected by HIV participated in the pilot trial. All participants completed the workshop and over 90 per cent indicated interest in future gender-affirming HIV care trainings. The interviews conducted after the workshop showed significant improvement in knowledge, attitudes, and perceived competency in gender-affirming care. This improvement was particularly noticeable among participants with less experience working with trans women in the previous year and less prior HIV experience.

Conclusion

TEACHH workshops could be an effective way to improve gender-affirming HIV prevention and care services. Scaling up the workshop to reach more health care and social service providers and trainees could increase access to gender-affirming health care and reduce HIV disparities among trans women.