Exploring Social Network Technology Use Among Transgender Women in Los Angeles County to Better Understand HIV Risk and Protective Behaviors

Introduction: Transgender women (hereafter “trans women”) face numerous risks for HIV including substance use, engagement in sex work, unemployment, low educational attainment, homelessness and hormone misuse. In LA County the estimated HIV prevalence among trans women is 21%; of these, 48% are African American trans women and 17% are Hispanic/Latina trans women. The use of social network sites (SNS) and technology-based (tech) networking platforms provide tools to develop and connect with social networks, inform behavioral norms and gain access to trans specific resources. The research seeks to understand how the social networks and SNS/tech use of trans women influence health risk and protective behaviors.

Methods: Between January and February 2015, we conducted four participant focus groups of trans women recruited from community-based organizations and through street outreach (N=31). Participants were asked open-ended questions regarding their social network composition, social support and SNS/tech use. Following verbatim transcription, two independent coders used qualitative software program ATLAS.ti© to code data and explore emergent themes.  The two coders came together to compare applied codes, themes and sub-themes. Inconsistencies were discussed and reconciled.

Results: Participants’ were racially/ethnically diverse (28% Black/African American, 28% Latina, 26% Caucasian/white, 5% API, 13% mixed/other) and their mean age was 36.5 (range: 20-72). Findings suggest that trans women use SNS/tech platforms to gain access to trans-specific health information and hormones. Participants reported using online forums comprised of trans women who share advice and information on trans-specific health concerns. Phone and online health chat lines were used to access health related resources, mental health counseling and suicide prevention. SNS/tech use was also seen by trans women as a safer alternative to street-based sex seeking and hookups. Further, trans women reported maintaining multiple SNS profiles to manage trans identity concerns. For example, some trans women indicated having diverse online profiles as a way to manage trans identity disclosure.

Conclusions: These findings suggest that SNS/tech use buffers risks associated with sex-seeking behaviors and allows trans women opportunities to manage identity disclosure to social network members and potential sexual partners. Technology-based interventions that leverage existing SNS/tech use and increase access to culturally relevant supportive services for trans women have the potential to influence health risk and protective behaviors and address disparities related HIV transmission and acquisition among this vulnerable population.