New York State Black Transgender Women's Life Cycle Development While Confronting HIV Prevention

Background and Purpose: This study explored the life cycle development and HIV prevention strategies for Black transgender women (BTW). The study aims are: (1) understanding their adaptive coping strategies; (2) describing primary and secondary HIV prevention decision making; and (3) identifying the structural and personal factors influencing the salience and meaning (affective, behavioral and cognitive) these women attribute to coping and prevention efforts.

Methods:  Using qualitative in-depth interviewing, 60 transgender women participated in three 90 minute interviews soliciting their life history narratives identifying the various domains sustaining their adaptive behaviors and HIV prevention efforts. The sample was New York State (NYS) Black transgender women who are:  (a) 21 or older; (b) psychologically capable of engaging in conversation; (c) English speakers; and (d) sexually active within the last six months.  Recruitment sites included HIV test and service provider agencies within the Capital District of NY, New York City, Rochester, and Buffalo. Flyers were distributed in gay clubs and civic organizations in all of the identified target areas.  The first interview explored and clarified the past, which informed the present.  The second interview provided the narrator with a time of reflection on what she is currently doing in her life.  The third interview focused on the participant’s meaning of her experience. The verbatim transcripts were fractured into discrete segments and sorted into categories, facilitating a comparative examination across participants of how racial, psychosocial and sociocultural contextual factors, life events, and internal resources influenced HIV prevention in the informants’ lives.  Atlas.ti categorical analysis explored factors influencing sexual risk. A three-stage analytic coding strategy including open coding, axial coding, and selective coding was used to address the study aims.

Findings: 49 of the 60 informants report HIV positive serostatus. The informants describe a series of strategies to mediate burgeoning female identities in male bodies to achieve emotional and psychological coherence. They describe coming out processes in their micro, meso and macro systems. Their efforts resulted in achieving a “womanly presentation.” Achieving a womanly presentation superseded their need to sustain HIV seronegativity.  The women report the lack of support and near constant struggle in achieving and maintaining their sense of self as impediments to adaptive coping and effective HIV prevention efforts. Despite their challenges, they reveal a determination to help younger transgender women achieve adaptive coping strategies, harm reduction, and HIV prevention efforts.

Conclusions and Implications: The study suggests the essential need for social work interventions to support the life cycle development of BTW’s adaptive coping.  The data also reveal culturally specific service needs for BTW.  Incorporating their strengths and capacities is an important starting point for service provision. Additional research is needed to understand the extent to which these challenges are present in the larger population of BTW and whether resources to support their psychological coherence is warranted as they manage primary and secondary HIV prevention. Finally, these data illuminate a question whether BTW may benefit from the psychological and emotional resources offered in black feminist and womanist theory?