By: Rafael Gonzalez & Bianca S. Hill, Bridge HIV CRS, San Francisco, CA, USA
There are approximately 1 million adults in the US who identify as transgender. And while we don’t know the true prevalence and incidence of HIV transmission within the community, we do know that about 2,300 folks who identify as trans were diagnosed with HIV between 2009 and 2014 in the United States. It’s estimated that HIV is 5 times the national average among transgender women and men. Yet transgender people account for a small proportion of participants in HIV prevention research studies, including vaccine research studies. With the growing prevalence of HIV among transgender men and women, it is essential to identify barriers and facilitators for transgender people to participate in HIV vaccine clinical trials.
Studies that are exploring the reasons for underrepresentation of trans people in HIV vaccine trials have pointed out that there is a need to develop recruitment strategies geared specifically toward the transgender community. Some of the barriers to address in such strategies include stigma, being unaware of or misinformed about HIV, mistrust of the scientific community, and concerns about possible vaccine side effects. But before any of these can even be addressed, how are we reaching trans-identified women and men?
Our ever-evolving culture is guiding us into digital spaces where visual advertisements grab the attention of people. It has been estimated that 72% of US adults visit social media websites and 12% of internet users access social media to research health-related issues.
To explore the acceptability of recruitment campaigns on social media sites/apps among transgender women and transgender men, Bridge HIV invited members of the community to a paid focus group. We sought to evaluate and compare the effectiveness of multiple styles of advertisements on social media sites/apps (such as Instagram) as a recruitment tool for HIV prevention studies. Specifically, we focused on obtaining feedback about the imagery, text/language, style, and overall message of the campaigns.
Participants identified the need to be inclusive and have visible transgender representation in an ad. The representation can take place in a variety of ways: visible trans flag colors, or including specific text that explicitly states the study is recruiting transgender women and men. If using models in a campaign, the consensus was to use people from within the community rather than opting for stock photos that use non-familiar or celebrity-style images.
A variety of messages were discussed that ranged from “Doing Good” by helping end HIV, to messages that were not directly about HIV but spoke to the community such as “Big and Bold. Beyond the Binary.” Participants unanimously agreed that messages such as “Do Good” imply judgment (that if you are not interested in participating or being involved in HIV prevention, you are doing bad). A transman under age 30 in the focus group stated, “People are imperfect, also, their goodness is not determined by their STI status.” On the other hand, some of the younger transwomen in the group felt that a tagline like “Big and Bold. Beyond the Binary” targeted them in a good way. They felt that the message is “really clever alliteration” and that “this is meant for me. This is meant for me to be reading right now.”
Animated or cartoon-based campaigns were appreciated among the group. Specifically, the conversation focused on a campaign created for HPTN 077 and HPTN 083, phase 1 and 2b (respectively) injectable PrEP studies that required participants to receive an injection in one of their butt cheeks. This campaign depicts a variety of cartoon butt cheeks in different shapes and sizes with text stating, “Show us yer cheeks!” Participants thought that cartoon-based images were a great way to be inclusive: “I like the butts, because I think they’re universal, and I think that isn’t – it’s not very gendered, and I like that.”
Our take-away at Bridge HIV is to create a customized campaign for the trans community, as opposed to creating one general campaign. While cartoon-based and text-based advertisements are acceptable, we think creating a campaign with members from the transgender community as models would be a great way to show the community that we are listening to their feedback, that we care, and that we want to cultivate our relationship with the community. It would also create a paid opportunity for the models, which is also a facilitator in establishing trust.
Rafael Gonzalez is the Community Program Manager and Bianca Hill is a RAMP Scholar at the Bridge HIV CRS.
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