Research Spotlight

Over 1,500 respondents to TM Survey

In May 2016, HART launched the Trans Masculine Health Survey, designed to engage transmen in identifying their highest priority sexual health needs and informing a research and advocacy agenda to improve trans-affirming health care. The research team, led by HART trans researchers Gus Klein and Charlie Solidum, successfully recruited over 2000 transmen and nonbinary individuals of trans masculine experience. Survey participants came from all 50 states and over 15 different countries, making it possibly the largest and most diverse sample of transmasculine individuals ever compiled. The survey was one of the first transmasculine-focused project to be funded by NIH.

HART is leveraging the results of this survey to inform provider education and enhance the quality of responsiveness of transgender health care. Based on these findings, Dr. Augustus Klein was invited to deliver the Stanley Biber Memorial Lecture on Transgender Health at the 36th annual conference of GLMA: Health Professionals Advancing LGBTQ Equality. His talk, entitled Providing Gender Affirming and Patient Centered Care to Trans Masculine Individuals is also the topic of a forthcoming paper in LGBT Health.

Survey data were also the first to document PrEP eligibility and uptake rates among transmasculine individuals, resulting in calls for increased attention to the HIV prevention needs of this population. Analyses are still ongoing -- stay tuned for updates on findings, recommendations, and future research.

Funded Research Projects

Trauma-Informed Investigation of TGNBI Experiences in HIV Stigma Research
Funded by the National Institutes of Health (NIMH) | R21MH131477 (Augustus Klein/Sarit Golub, MPI)
July 2022- June 2024

This project is designed to address critical gaps in research on HIV stigma among transgender, non-binary, and gender diverse individuals (TGNBGDI) by examining experiences of stigma within the research context and identifying strategies for improving data quality and reducing unintentional harm in study recruitment, methodology, and/or implementation. This study employs a mixed methods design and will: 1) conduct in-depth interviews with TGNBGDI, stratified by gender identity and HIV status, to better understand how they understand and experience participation in HIV related stigma and discrimination research; 2) conduct in-depth interviews with both investigators who conduct HIV-related stigma and discrimination research with TGNBGDI and mental health professionals who provide care to TGNBGDI to better understand perceptions of and experiences with conducting stigma and discrimination research with TGNBGDI, and compile existing strategies for mitigating harm; and 3) utilize a modified Delphi technique to develop a set of empirically-informed guidelines for conducting HIV stigma research with TGNBGDI.

Addressing Missed Opportunities in Status-Neutral HIV Prevention and Treatment among Transgender Men and Transmasculine Non-Binary Individuals
Funded by the National Institutes of Health (NIAID), CFAR Supplement Grant | P30AI124414-07 (Klein, PI)
September 2022 - April 2024

This study is a collaboration with Lyon-Martin Community Health Center and is designed to collect pilot data on how best to initiate, integrate, and sustain a holistic, status-neutral sexual health care approach into gender affirming primary care to increase access to and uptake of HIV prevention and care among transgender men and transmasculine non-binary individuals (TMBNI). The specific aims of this project are to: (1) Assess factors at the organization, provider, and patient-levels that are likely to influence acceptability, appropriateness, and feasibility of the adaptation and implementation of GOALS within community-based gender-affirming health care (CB-GAHC) for TMNBI; (2) Systematically adapt GOALS using the Ecological Validity Model to ensure responsiveness and compatibility with the local EHE plan, community clinic setting, and needs of TMNBI; and (3) Develop a research implementation blueprint to guide the testing of GOALS for TMNBI (GOALS-TMNBI) in a large-scale implementation science trial.

FIRED UP: A Community-Based Cohort Study (COMPLETED)
Funded by the National Institutes of Health (NIMH) | R21MH116757 (Golub, PI, Augustus Klein, Co-I

This project collaborates with Callen-Lorde Community Health Center to identify factors associated with PrEP uptake and persistence among transgender women, and examine the association between self-reported PrEP adherence, tenofovir levels, and estradiol levels among transgender women taking PrEP. Many transgender women express concerns about the interaction between PrEP medication and gender-affirming hormones; this project is designed to provide data for the community to directly answer and address this concern. 

Leveraging Biomedical HIV Prevention as a Gateway to Gender Affirming Health Care (COMPLETED)
Funded by the National Institutes of Health (NIAAA) | R01AA022067-04S1 (Sarit Golub, PI; Augustus Klein, Co-I)

This project is designed to identify social, behavioral, and structural factors that influence access to and utilization of sexual heath and primary care services among transgender men. Through a combination of qualitative and quantitative data collection, we are working to develop a valid, reliable, and affirming assessment tool for engaging transmen in conversations about their sexual health. Transmen are often left out of conversations around PrEP, and this project is also focused on developing strategies for greater inclusion and leveraging engagement of PrEP toward improving overall health of TM. 

Student Research and Pilot Projects

Enhancing Gender-Affirming Sexual Health Care for Transgender, Non-Binary, and Gender Diverse Individuals (Klein, PI)

This mixed-methods project is part of our larger research agenda to identify social, behavioral, and structural factors that influence access to and utilization of sexual health and primary care services among transgender individuals and improve the quality of care they receive. Through a combination of qualitative and quantitative data collection, we are working to develop valid, reliable, and affirming assessment tools for engaging patients in conversations about their sexual health. 

Family Decision-Making and Quality of Life Goals for Gender Expansive Youth (Klein/Golub, PIs)

This project is being conducted in collaboration with Camp Aranu'tiq and surveys parents of transgender and gender-expansive youth to better understand and support decision-making about hormone therapy and other interventions. The goal of this project is to compile data from families about their goals, decision-making processes, and experiences in order to develop a framework that might be useful for new families embarking on this journey. 

Facilitators and Barriers to Pre-exposure Prophylaxis (PrEP) Use among Transgender Women at Risk for HIV (Dissertation Project; Klein, PI)

This project focuses on the barriers to PrEP access experienced by transgender women, and the potential for PrEP to improve the sexual health care transwomen receive. Through interviews with transgender women who have chosen to use PrEP as well as women who have decided that PrEP is not the right prevention choice for them, this study examines sexual health decision-making for transgender women and the ways in which programs and policies can be designed to support them.