SUMMARY/ABSTRACT
Transgender and non-binary (TGNB) persons experience intimate partner violence (IPV) at alarming rates twice that
of their cisgender peers. Prior work has linked IPV to sexual risk behavior and increased risk for HIV seroconversion
among TGNB, but less is known about the impact of IPV on HIV and sexually transmitted infection (STI) testing, pre-
exposure prophylaxis (PrEP) uptake, and persistence among TGNB. While past findings suggest the potential for IPV
to have a strong deleterious effect on HIV prevention continuum engagement, IPV experiences and impacts on
HIV/STI risk and prevention behaviors have yet to studied among a diverse group of TGNB persons. Additional
research is currently needed to model pathways between IPV and HIV risk for subgroups of trans feminine (TF), trans
masculine (TM), and gender non-binary (GNB) persons. Guided by a framework that combines Syndemic and
Minority Stress Theory, the proposed innovative observational cohort study will examine how specific forms of IPV
(e.g., physical, sexual, emotional, controlling gender expression and/or transition) in the context of steady or casual
intimate relationships contribute to HIV/STI risk and protective behaviors among subgroups of TGNB persons over
a 24-month timeframe. Specifically, we aim to: 1. Using qualitative methodologies, explore the perceived associations
between IPV, relationship characteristics and dynamics, and HIV risk and prevention behaviors among gender
diverse TGNB persons. 2. Examine gender-based differences in the longitudinal associations of IPV with HIV testing,
PrEP uptake, PrEP persistence, STI diagnosis (primary outcomes), condomless sex, and HIV seroconversion
(secondary outcomes) among a racially and ethnically diverse cohort of TGNB persons (TF, TM, and GNB groups). 3.
Determine the individual-, interpersonal-, network-, community-, and structural-level risk and resilience factors that
mediate (or moderate) the associations between IPV and HIV risk and protective behaviors for each group. 4. Make
recommendations for interventions that interrupt the pathways between IPV and HIV/STI risk based on quantitative
data from the cohort and qualitative data, guided by technical experts. We will assess sexual risk behavior, conduct
HIV and STI testing, and assess PrEP uptake and persistence over the 24 months of follow-up. We hypothesize that
there will be differences in the frequency, severity, and overall impact of IPV on HIV/STI risk among subgroups of
TGNB persons. We also suspect greater frequency of IPV will be associated with history of childhood abuse, mental
health problems, substance use, sexual risk taking and lower levels of HIV testing, PrEP uptake, and PrEP persistence.
We anticipate that alcohol and substance use among participants and their partners will be highly associated with
episodes of IPV and with HIV risk behavior. We also hypothesize that experiences of gender affirmation, coping skills
and social support will mediate the effects of IPV on risk behavior, HIV testing, PrEP uptake, and PrEP persistence.
The proposed study will advance our understanding of both the risk and resiliency factors relevant to preventing and
reducing IPV, reducing IPV-associated risk behaviors, and increasing HIV protective behaviors among diverse TGNB
persons. This research will inform the development and adaptation of IPV, HIV, and substance abuse interventions
for TGNB persons.
