Pilot Results from the First HIV/AIDS Intervention Among Transgender Women in the Middle East: Gender Affirmation and Social Support from Within Trans Communities in Beirut, Lebanon

Abstract

Transgender women are 49 times more likely to become HIV positive than all adults worldwide. Data were unavailable for trans women's sexual and mental health in the Middle East and North Africa until 2015-2016, when HIV prevalence (10%) and suicide attempt (46%) rates were established in Lebanon. Because of the lack of evidence-based interventions for this marginalized group, the purpose of this study was to pilot test an adapted intervention, ''Baynetna,'' to assess preliminary impact on mental and sexual health. Using the gender affirmative model and community connectedness and social cohesion constructs, we pilot tested Baynetna among sixteen trans women, who attended 6 weekly 3-h trans-facilitated group-delivered sessions in Beirut with post-test assessments at 1, 3, and 6 months. Each participant acted as her own control; we used paired t-tests to assess changes at follow-up to evaluate potential differences in outcomes. Positive directionality in intervention impact on gender affirmation satisfaction, community connectedness, and social cohesion was demonstrated. An increase in HIV testing proportion between 6 months before and after enrollment was achieved. Higher social cohesion was associated with less suicidal thoughts (p = .05). There was a significant (p = .019) relationship between more community connectedness and lower depression scores. War event exposure was associated with higher anxiety (p = .02; p = .004). Those who reported never having had a sexually transmitted infection had higher gender affirmation satisfaction scores (7.5, 95% confidence interval: 1.4-13.6) (p = .019). Increases in community connectedness, social cohesion, and gender affirmation satisfaction scores confirm Baynetna's proposed mechanisms of impact. Proportional HIV testing increases demonstrate prevention objectives' progress. The significant results contribute to confidence in Baynetna's mechanisms of action and support the hypothesis that the Gender Affirmation model is applicable to the Lebanese context. We have shown for the first time that the adapted intervention, and its constructs, are applicable in this context outside the United States.

Community-Based Resistance Strategies among a Group of Trans Women in Lima, Peru during the COVID-19 Pandemic

“…On the other hand, bonding capital (i.e., social cohesion to resist institutionalized violence) contributed to influencing institutions across power differentials (i.e., police department policies regarding trans people and media representations of trans individuals). Overall, results paralleled existing findings from trans women communities in Peru (Clark et al, 2020;Maiorana et al, 2016;Perez-Brumer et al, 2017) and globally (e.g., Hwahng et al, 2019;Kaplan, El Khoury, Wehbe, Lize, & Mokhbat, 2020;Stanton, Ali, & Chaudhuri, 2017).…”

Self-Testing as a Hope to Reduce HIV in Transgender Women—Literature Review

“…HIV prevalence among TGW is estimated to be approximately 14.2%, which is higher compared to other vulnerable populations such as gay, bisexual, and other men who have sex with men (10.6%) [ 19 , 20 , 21 ]. Additionally, a similar trend is observed for TGW in the Middle East and North Africa, where infection rates continue to rise [ 5 , 9 ]. However, results from a study in São Paulo, Brazil, indicate an even higher prevalence of HIV among TGW compared to data from around the world [ 2 , 22 ].…”

“…They are a diverse group of people who were assigned male sex at birth but mostly identify as women, trans women, and/or transfeminine. They are estimated to be more than 48 times more likely to be infected with HIV than cis women (those whose gender identity matches that assigned at birth) of reproductive age [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Transgender women of color in particular face high rates of infection and low use of important HIV prevention tools [ 10 , 11 ].…”

Sexual and gender minority health in the Middle East and North Africa Region: A scoping review

“…In two studies, researchers adapted and tested an HIV prevention intervention, TransAction (Baynetna), to assess feasibility and acceptability among transgender women in Lebanon. Participants in these studies evaluated the intervention to be feasible and acceptable, and HIV testing increased among study participants ( Kaplan et al., 2020 ; Kaplan et al., 2019 ).…”