Transgender women are significantly more likely to have HIV than the general population, while studies show they are less likely to engage in HIV prevention strategies. The disconnect may exist because they receive insufficient information about prevention medicine, possibly due to systemic bias. Transgender women have reported challenges receiving support from healthcare providers. And pharmaceutical companies, though they devote large budgets to advertising Pre-Exposure Prophylaxis (PrEP) drugs that can help prevent HIV, tend to leave transgender women out of their campaigns.
“They just don't see themselves in any of the marketing. Their specific issues—like ‘how is this going to affect the hormones that I take?’—aren’t being addressed by the marketing at all,” says Sarah Bass, associate professor of social and behavioral sciences and director of Temple’s Risk Communication Laboratory. As a result, she says, “they are a highly at-risk group because they have not had a lot of really targeted interventions.”
Bass is leading a new project aimed at getting HIV prevention information to transgender women in a different way: via social media influencers. The three-year study, funded by the National Institute of Mental Health, will recruit and train popular online influencers to participate in a test intervention that will include targeted messages about using PrEP. The specific messaging was honed in a prior study that surveyed transgender women about their experiences and concerns. Both the prior and current project are in partnership with Sophia Zamudio-Haas and Jae Sevelius of the Center of Excellence for Transgender Health at the University of California, San Francisco (UCSF).
Bass’s Risk Communication Lab at Temple adapts consumer marketing techniques and information diffusion theory for use in public health communications. Her prior study with UCSF, and a current investigation in collaboration with Children's Hospital of Philadelphia, have employed a method called perceptual mapping to build visual representations of how transgender women conceptualize their concerns around HIV and its prevention. A technique called message vector modeling then was used to design messaging likely to make an impact by addressing specific barriers transgender women may have to using PrEP. The early studies identified, among other things, that messaging should be varied for different age groups,
“We developed materials like posters and palm cards, and a trans female artist created a comic book. UCSF has also developed interventions using peer-education components, where transgender women would talk others through the process of getting on PrEP. So we started to think about meshing these things together,” Bass explains.
A community advisory board is helping to identify influencers for the new project. Influencers will use prepared information in their videos, memes and other postings, but also be allowed to present information in a way that is organic to them.
“We can take the information we have developed and make it Instagrammable and pair it with an influencer who’s going to be very positive about PrEP, providing information about where people can get it, answer questions, have events, do Q&A sessions, all sorts of things,” Bass explains. “The idea is that they’ll get information in a way that makes sense to them, from somebody they trust.”
The project is teaming with clinical partners in Philadelphia and San Francisco that can deliver PrEP services. And the researchers will gauge the program’s effectiveness in encouraging uptake of PrEP medication among social media follows via surveys and measurements taken from hair samples.
“This is a pioneering way to use social media to get information out, to focus on specific barriers transgender women might have to using PrEP to stay safe from HIV infection,” Bass says. “We’re grateful that the NIMH saw the innovativeness of it. It'll be really interesting.”