Estimates suggest that one in five transgender girls may be HIV positive In the face of this health disparity, the near-complete absence of gender-inclusive healthy sexuality programs is deafening. To address the lack of gender inclusive HIV prevention programming, we propose to develop and test #TranscendentHealth. Content will focus on providing girls with a panoply of risk reduction strategies, including frequent HIV/STI testing and initiating PrEP, so that they can choose options that fit best for them. Messaging will be gender affirming while increasing one’s HIV preventive information, motivation, and behavioral skills. Content will foster pride in girls’ gender identity and reduce internalized transphobia they may be experiencing. We will harness the reach and wide adoption of text messaging among youth to deliver intervention content. This national reach will increase its generalizability and translational properties. In response to RFA-OD-19-029, this proposal addresses NIMH’s high priority area of research: Intervention research to improve HIV prevention and treatment outcomes for transgender individuals that focuses on the influences of sex and gender (Strategic Goal 1.3). Specifically, we aim to: Specific Aim 1: Explore how the intersectionality of sex and gender inform the sexual decision making of transgirls 14-18 years of age (n=80). Little is known about how transgirls decide when and with whom to have sex or not, as well as how their understanding of their gender within the context of their sex influences their sexual decision-making. To explore these issues, we will conduct online focus groups. Specific Aim 2: Iteratively develop #TranscendentHealth, a gender inclusive HIV prevention program for transgirls, with ongoing input from transgirls (n=35). We will integrate findings from the focus groups into content tailored to the lived experiences of transgirls 14-18 years of age. To ensure that the messaging is affirming and acceptable, we then will conduct Content Advisory Teams (CATs), and then t a beta test to confirm the protocol. Specific Aim 3: Test the #TranscendentHealth HIV prevention program with transgirls 14-18 years of age across the United States (n=200). Our main outcome measures will be feasibility and acceptability. Behavioral outcomes will be exploratory and include those on the HIV prevention continuum41: 1) acceptability of, 2) motivation for, and 3) uptake of PrEP, if clinically indicated; and 3) HIV/STI testing and receipt of results at 3-month follow-up. Photo-verified testing also will be explored. Specific Aim 4: Understand how the intersectionality of sex and gender impact the intervention experience. We will examine whether transgirls who are undergoing gender affirming hormone therapy, have internalized transphobia, and different gender identities experience the intervention differently than other gender minority teens.

If, over time, data suggest that #TranscendentHealth impacts HIV preventive behavior at the population level, it will be unique in that it can be quickly and cost effectively scaled up to impact thousands of trans girls.