Associations Between Social Support Availability and HIV Risk and Protective Factors in a U.S. Sample of Adults with Diverse Transgender Identities.

Purpose: There is conflicting evidence on how different types of social support may attenuate human immunodeficiency virus (HIV) risk or may even promote health behaviors in transgender (trans) and nonbinary populations. Drawing on Social Support Theory, we assessed associations between emotional, instrumental, and informational social support and HIV risk and protective factors in a U.S. sample of trans and nonbinary adults. We investigated whether such associations differed for trans men, trans women, and nonbinary individuals. Methods: Data were drawn from the Transgender Stress and Health Study, an online survey (N = 300), conducted in 2014-2015. We used Poisson regressions to measure the relationship between social support availability and HIV testing, substance use, and sexual risk behaviors for each gender subgroup. Results: Multivariate analyses revealed that, controlling for social support availability, nonbinary individuals were less likely to report past year HIV testing (incidence rate ratio [IRR] = 0.56; 95% confidence interval [CI] 0.36-0.89) than trans men (ref). Instrumental support availability was associated with substance use (IRR = 1.3; 95% CI 1.01-1.6), and this association was stronger for trans women (IRR = 2.1; 95% CI 1.1-4.04). Trans women were more likely to report sexual risk behavior across all types of social support, controlling for social support availability. Conclusion: We found key differences in social support availability, HIV testing, substance use, and sexual risk behavior. Our results suggest that trans men, trans women, and nonbinary individuals may have unique HIV prevention needs, and should be treated as distinct study groups in further research.

Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study.

BACKGROUND: Although gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by human immunodeficiency virus (HIV) infection, few test for HIV at regular intervals. Smartphone apps may be an ideal tool to increase regular testing among MSM. However, the success of apps to encourage regular testing among MSM will depend on how frequently the apps are downloaded, whether they continue to be used over months or years, and the degree to which such apps are tailored to the needs of this population. OBJECTIVE: The primary objectives of this study were to answer the following questions. (1) What features and functions of smartphone apps do MSM believe are associated with downloading apps to their mobile phones? (2) What features and functions of smartphone apps are most likely to influence MSM's sustained use of apps over time? (3) What features and functions do MSM prefer in an HIV testing smartphone app? METHODS: We conducted focus groups (n=7, with a total of 34 participants) with a racially and ethnically diverse group of sexually active HIV-negative MSM (mean age 32 years; 11/34 men, 33%, tested for HIV ≥10 months ago) in the United States in Miami, Florida and Minneapolis, Minnesota. Focus groups were digitally recorded, transcribed verbatim, and deidentified for analysis. We used a constant comparison method (ie, grounded theory coding) to examine and reexamine the themes that emerged from the focus groups. RESULTS: Men reported cost, security, and efficiency as their primary reasons influencing whether they download an app. Usefulness and perceived necessity, as well as peer and posted reviews, affected whether they downloaded and used the app over time. Factors that influenced whether they keep and continue to use an app over time included reliability, ease of use, and frequency of updates. Poor performance and functionality and lack of use were the primary reasons why men would delete an app from their phone. Participants also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors. CONCLUSIONS: Mobile apps for HIV prevention have proliferated, despite relatively little formative research to understand best practices for their development and implementation. The findings of this study suggest key design characteristics that should be used to guide development of an HIV testing app to promote regular HIV testing for MSM. The features and functions identified in this and prior research, as well as existing theories of behavior change, should be used to guide mobile app development in this critical area.