Critical Review of Micro Interventions for Transgender Women of Color

Background and Purpose: Transgender Women of Color (TWOC) experience disparities such as HIV transmission, underground economy work, housing discrimination, domestic violence, homicide, healthcare access, poverty, and incarceration at rates that are substantially higher than cisgender populations and other transgender subgroups. TWOC are a hidden and vulnerable population in need of targeted interventions specific to their unique needs. A systematic review was conducted in order to explore and appraise micro interventions specifically designed for TWOC.

Methods: Under Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA) a search of 6 electronic databases (PsychInfo, Gender Watch, Medline, CINAHL, Sociology Database, Social Services Abstracts) was conducted. Articles from peer reviewed journals from 1974 to February 27, 2020 were selected. A pool of 42 term variations to the main concepts transgender, intervention, and “of color” were included in the database searches. The criteria for the studies included: a) a sample size over 60 b) at least 80% of the sample identifying as TWOC c) participants 18 years or older d) interventions within the United States e) implementation of an intervention of any kind f) report of at least one quantifiable outcome at baseline and (g) utilization of pre-post-design. The Robbins-I tool was used to assess risk of bias within 7 domains.

Results: The reviewer independently screened the 4419 titles and abstracts. After completing the independent screening process four studies met the inclusion criteria. All four of the studies were quasi-experimental. Sample sizes ranged from 63 to 163 participants. The majority of the participants, 77% or higher, identified as either Black/African American or Latinx. The primary focus for all studies was HIV prevention. All four studies incorporated transgender individuals as service providers within the interventions. The results from the studies reported significant improvement in HIV preventative behaviors (lower detectable HIV viral loads, retention to HIV care, fewer unprotected intercourse acts, limiting sexual partners). In addition to HIV prevention, the four studies included adjunctive services as a component to the intervention (legal aid, housing, employment, primary care, mental health). Deviations from intended intervention design, reliance of self-report for significant findings, and lack of randomized sample produced increased risk of reporting bias.

Conclusions and Implications: Findings from the systematic review reveal TWOC-specific interventions for HIV prevention produce significant and promising results. These findings are limited in their research design and lack of randomization. Future intervention efforts to initiate randomized control trials for HIV prevention and other targeted interventions specifically for TWOC should be promoted and developed by social work researchers given the skills and knowledge unique to the profession.