Using Community-Based Participatory Research Methods to Increase Trust between Law Enforcement and Latina Transgender Women and Improve HIV-Related Outcomes

Background and Purpose: HIV-related inequities continue to affect Latinx communities, especially Latina transgender women (LTGW). LTGW experience high levels of violence, stigma, and discrimination, which may lead to increased HIV risk behaviors. In the 2015 U.S. Transgender Survey, among the respondents identifying as Latinx, 48% reported being sexually assaulted at some point in their lifetime and 12% reported being sexually assaulted in the past year. However, 59% said they would feel somewhat or very uncomfortable asking the police for help. Not seeking or receiving support after trauma exacerbates the negative physical and mental health outcomes, as well as HIV care continuum outcomes. The goal of this study is to develop an intervention, the first to address the need, as identified by LTGW for LTGW, to increase trust between law enforcement and LTGW, and improve HIV-related outcomes, using community-based participatory research methods.

Methods: We recruited LTGW participants from a Latinx LGBT community-based organization. We conducted 20 qualitative semi-structured interviews with 15 LTGW and 5 key law enforcement officers leading professional development efforts in Los Angeles, CA. We used qualitative content analysis to allow for themes about potential intervention components to emerge through a bottom-up, iterative coding process. Qualitative results were presented at a one-day structured community workshop with LTGW and law enforcement participants, to develop an intervention using a participatory engagement process.

Results: The following three themes emerged from our analysis: 1.) Include relevant topics (e.g., respect, empathy, safety, and profiling) in law enforcement training; 2.) Link LTGW to resources through law enforcement; and 3.) Create spaces for positive interactions between LTGW and law enforcement to build trust.

Conclusions and Implications: After a traumatic experience, victims should feel comfortable reporting the assault to law enforcement. Recent trauma is associated with antiretroviral failure; thus, the role of law enforcement responding to any traumatic experience/event faced by LTGW is key to continued retention in care and ultimately, achievement of viral suppression. The intervention aims to improve mental health (e.g., through increased help-seeking, quality social support, and likelihood/comfort reporting crimes) and HIV-related health behaviors (e.g., retention in preventive care, medication adherence) by providing a safe space to build trust and mutual empathy between law enforcement and LTGW, using indirect and direct, facilitated contact. Law enforcement should have access to local linkage to care resources and/or counsel LTGW on the importance of following up with their provider.