AJPH
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow purchase articles
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Right arrow Get other permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (5)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Nemoto, T.
Right arrow Articles by Sugano, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nemoto, T.
Right arrow Articles by Sugano, E.
Related Collections
Right arrow HIV/AIDS
Right arrow Health Education
Right arrow Lesbian/Gay/Bisexual/Transgender Persons
Right arrow Drugs
March 2005, Vol 95, No. 3 | American Journal of Public Health 382-384
© 2005 American Public Health Association
DOI: 10.2105/AJPH.2004.040501

FIELD ACTION REPORT

Promoting Health for Transgender Women: Transgender Resources and Neighborhood Space (TRANS) Program in San Francisco

Tooru Nemoto, PhD, Don Operario, PhD, JoAnne Keatley, MSW, Hongmai Nguyen, BS and Eiko Sugano, MPH

The authors are with the Center for AIDS Prevention Studies, University of California, San Francisco.

Correspondence: Requests for reprints should be sent to Tooru Nemoto, PhD, Center for AIDS Prevention Studies, University of California, San Francisco, 74 New Montgomery St, Suite 600, San Francisco, CA 94105 (email: tnemoto{at}psg.ucsf.edu).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 PROGRAM DESCRIPTION
 EVALUATION AND DISCUSSION
 NEXT STEPS AND LESSONS...
 References
 

Transgender women are at high risk for HIV, substance abuse, and mental health problems. We describe a health promotion intervention program tailored to transgender women in San Francisco.

The program creates a safe space for providing transgender-sensitive education about HIV risk reduction, substance abuse prevention, and general health promotion. Transgender health educators conduct workshops and make referrals to appropriate substance abuse treatment programs and other services in the community.

Evaluation findings indicate that this community-tailored intervention may be an effective way to reach transgender women and reduce sexual risk behaviors, depression, and perceived barriers to substance abuse treatment.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
PROGRAM DESCRIPTION
 EVALUATION AND DISCUSSION
 NEXT STEPS AND LESSONS...
 References
 
THE TERM TRANSGENDER refers to individuals whose gender identity and gender expression contrast with their biological sex.1 In San Francisco, the male-to-female transgender community (individual members are referred to here as transgender women) shows some of the highest rates of HIV incidence, substance use, and mental health problems among all groups at risk.2–4 Qualitative research indicates that ecological and psychosocial factors associated with transgender identity—such as discrimination, stigma, health service barriers, and poor social support—contribute to HIV risk and co-occurring health problems.5,6

Researchers have urged the public health community to address health disparities facing transgender individuals.7–11 Many service providers are not trained in transgender care issues and might be insensitive to the psychosocial needs of transgender clients. Transgender women have reported discrimination in health services, and often they are uncomfortable disclosing their gender history to providers. This report describes a program for transgender women in San Francisco, the Transgender Resources and Neighborhood Space (TRANS) program, designed to reduce HIV risk and substance use.


   PROGRAM DESCRIPTION
TOP
 ABSTRACT
 INTRODUCTION
 PROGRAM DESCRIPTION
EVALUATION AND DISCUSSION
 NEXT STEPS AND LESSONS...
 References
 
TRANS is a collaborative project joining researchers, coordinators from local community-based organizations, health and social service providers, and community advocates in San Francisco. The program provides a welcoming, safe venue in which to offer culturally and gender-sensitive health education to transgender women. It operates in a space located adjacent to San Francisco’s Tenderloin district, where many transgender women live or socialize. This space houses private offices for health educators (all of whom are transgender women), living room area, large conference rooms, shower facility, and a resource closet (donated clothing and accessories free to those in need). Contacted through street outreach and referrals from collaborating organizations, transgender women who reside or work in San Francisco and are aged 18 years or older are invited to the TRANS site, use resources, and participate in health education workshops.

TRANS offers 18 group workshops organized around 3 domains: (1) sex, relationships, and health (offered every Tuesday); (2) reducing drug use and improving coping skills (every Thursday); (3) general life needs (every Friday; Table 1Go). These 1-hour workshops, which are held throughout the year, are conducted by transgender health educators in both English and Spanish. Health educators use multiple group facilitation techniques, including interactive discussions, personal expression exercises, videos and media, and guest lectures.


View this table:
[in this window]
[in a new window]
  		TABLE 1—— Curriculum for Transgender Resources and Neighborhood Space (TRANS) Project
 
Upon their first visit to the TRANS space, participants voluntarily complete a behavioral risk intake assessment, which measures sexual behaviors, substance use, attitudes toward substance abuse treatment, HIV knowledge, depression, self-esteem, and transgender community involvement. They are then informed of the health education workshops and asked to attend at least 10 of the 18 workshops to be considered program graduates. Our project goals are to facilitate transgender women in socializing at the TRANS site and participating in workshops according to their own schedule, although health educators encourage them to finish 10 workshops. Program graduates voluntarily take a posttest assessment within 2 weeks of their final workshop. At yearly graduation ceremonies, participants who attended 10 workshops are acknowledged for their contribution to the TRANS project and awarded a certificate of completion.


   EVALUATION AND DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 PROGRAM DESCRIPTION
 EVALUATION AND DISCUSSION
NEXT STEPS AND LESSONS...
 References
 
Between October 2001 through September 2003, a total of 359 eligible participants completed the pretest risk assessment interview, 206 enrolled in the health education workshop program, and 109 completed 10 workshops and provided posttest data. Participants who completed 10 workshops did so in 6 weeks, on average.

We examined data from participants who completed 10 workshops. Preliminary pre- and posttest findings showed significant reductions in levels of sexual risk during the past 30 days, perceived barriers to substance abuse treatment programs, and depression (Table 2Go). Marginal reductions in unprotected receptive anal sex and alcohol use during the past 30 days were also found. However, no changes in illicit drug use, HIV knowledge, self-esteem, and transgender community involvement were found.


View this table:
[in this window]
[in a new window]
  		TABLE 2—— Comparison of Baseline and Follow-Up Data for 109 Transgender Resources and Neighborhood Space (TRANS) Participants
 
A major limitation to the results is the absence of a control group. Marginally significant results should be interpreted with caution; however, a longer time lag for administering follow-up surveys might have allowed for more noteworthy behavioral changes, particularly with regard to changes in illicit drug use. Findings might be biased because of the low completion rate (30% of those who completed the pretest risk assessment interview finished 10 workshops), although it is important to note that participants were not required to complete the workshop series. Furthermore, participants who completed 10 workshops reported significantly less illicit drug use at baseline than those who did not.


   NEXT STEPS AND LESSONS LEARNED
TOP
 ABSTRACT
 INTRODUCTION
 PROGRAM DESCRIPTION
 EVALUATION AND DISCUSSION
 NEXT STEPS AND LESSONS...
References
 
The findings suggest that this community-tailored intervention is associated with reductions in sexual risk, alcohol use, perceived barriers to substance use services, and depression. In response to community demand, the next wave of the health education program will include transgender men and gender variant individuals—people who do not adhere to traditional gender categories. Curricula will be refined through community feedback to reflect the needs of the larger transgender community, and rigorous program evaluation will be conducted.

Although we acknowledge that the progressive climate of San Francisco differs from that of other areas, variations of our TRANS project can be replicated elsewhere. For example, the contents of our TRANS curriculum can be used for developing transgender-sensitivity training programs for health service providers.

Work with this community was facilitated through alliances with transgender opinion leaders and community organizations to assess needs, define priorities, and develop locally tailored programs. A major difficulty was securing community members’ trust and overcoming insensitivity and lack of knowledge about transgender health issues among service providers. In addition, this is a very fluid community—in terms of both geographical movement and community identification. Many transgender individuals, especially younger ones, move frequently, and there is a tendency for some transgender women to disengage from the transgender community as a way to minimize stigma.


KEY FINDINGS

  • Transgender women have disproportionate risk for HIV and related health problems, and tend to distrust and underuse general health and social services.
  • Our community-tailored health intervention program creates a safe space where transgender women feel comfortable discussing issues related to gender history, sexual risk, depression, and substance use.
  • Findings show significant reductions in sexual risk, alcohol use, perceived barriers to substance use services, and depression among program graduates.
  • Collaborations among researchers, members of the transgender community, community-based organizations, and health providers are essential to working with the transgender population.
  • Health interventions for transgender women should be delivered by transgender peers.

 

We have learned that it is crucial to hire transgender women as professional health educators who can increase accessibility to this stigmatized population and serve as role models. Creating a safe physical space where transgender women feel comfortable discussing their health issues can also increase the success of intervention programs for this community.


   Acknowledgments
 
This research was supported by the Substance Abuse and Mental Health Services Administration (grant H79TI12 592).

We thank collaborating community-based organizations and substance abuse treatment agencies for their assistance and all project participants who volunteered their time and personal information to this study.

Note. The contents of this article do not necessarily represent the views of the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.

Human Participant Protection
This study was approved by the Committee on Human Research at the University of California, San Francisco.


   Footnotes
 
Peer Reviewed

Contributors
T. Nemoto conceived the study and supervised all aspects of its implementation and analysis. D. Operario was involved in analysis, interpretation, and manuscript preparation. J. Keatley coordinated the study implementation. H. Nguyen and E. Sugano assisted with data analysis and manuscript preparation.

Accepted for publication June 26, 2004.


   References
TOP
 ABSTRACT
 INTRODUCTION
 PROGRAM DESCRIPTION
 EVALUATION AND DISCUSSION
 NEXT STEPS AND LESSONS...
 References
 
1. Israel GE, Tarver DE. Transgender Care: Recommended Guidelines, Practical Information, and Personal Accounts. Philadelphia, Pa: Temple University Press; 1997.

2. Clements-Nolle K, Marx R, Guz-man R, Katz M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001;91: 915–921.[Abstract]

3. Kellogg TA, Clements-Nolle K, Dilley J, Katz MH, McFarland W. Incidence of human immunodeficiency virus among male-to-female transgendered persons in San Francisco. J Acquir Immune Defic Syndr. 2001;28:380–384.

4. Nemoto T, Operario D, Keatley J, Han L, Soma T. HIV risk behaviors among male-to-female transgender persons of color in San Francisco. Am J Public Health. 2004;94:1193–1199.[Abstract/Free Full Text]

5. Bockting WO, Robinson BE, Rosser BR. Transgender HIV prevention: a qualitative needs assessment. AIDS Care. 1998;10:505–525.[CrossRef][Web of Science][Medline]

6. Nemoto T, Operario D, Keatley J, Villegas D. Social context of HIV risk behaviors among male-to-female transgenders of color. AIDS Care. 2004;16: 724–735.[CrossRef][Web of Science][Medline]

7. Lombardi E. Enhancing transgender health care. Am J Public Health. 2001;91:869–872.[Abstract]

8. Feinberg L. Trans health crisis: for us it’s life or death. Am J Public Health. 2001;91:897–900.[Web of Science][Medline]

9. Lombardi E, van Servellen G. Building culturally sensitive substance abuse programs for transgendered populations. J Subst Abuse Treat. 2000;19: 291–296.[CrossRef][Web of Science][Medline]

10. Nemoto T, Operario D, Keatley J. Health and social services for male-to-female transgenders of color in San Francisco. Int J Transgenderism. In press.

11. Bockting WO, Rosser BR, Scheltema K. Transgender HIV prevention: implementation and evaluation of a workshop. Health Educ Res. 1999;14: 177–183.[Abstract/Free Full Text]

12. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.[CrossRef]

13. Rosenberg M. Society and the Adolescent Self-Image. Princeton, NJ: Prince-ton University Press; 1965.

14. Luhtanen R, Crocker J. A collective self-esteem scale: self-evaluation of one’s social identity. Pers Soc Psychol Bull. 1992;18:302–318.[Abstract]




This article has been cited by other articles:


Home page
 Am. J. Public HealthHome page
J. W. Edwards, D. G. Fisher, and G. L. Reynolds
Male-to-Female Transgender and Transsexual Clients of HIV Service Programs in Los Angeles County, California
Am J Public Health, June 1, 2007; 97(6): 1030 - 1033.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow purchase articles
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Right arrow Get other permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (5)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Nemoto, T.
Right arrow Articles by Sugano, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nemoto, T.
Right arrow Articles by Sugano, E.
Related Collections
Right arrow HIV/AIDS
Right arrow Health Education
Right arrow Lesbian/Gay/Bisexual/Transgender Persons
Right arrow Drugs

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2005 by the American Public Health Association