TransAction
TransAction was developed in 1995 by Dr. Cathy Reback, in collaboration with trans women in Los Angeles County, to meet the needs of trans women in the urban core of Los Angeles County, many of whom experience syndemic HIV risk factors.
TransAction is a multi-tier HIV risk reduction intervention that utilizes both individual- and group-level interventions. The program consists of a comprehensive, culturally appropriate, continuum of services that include street- and venue-based outreach, one-on-one peer-led individual risk reduction counseling sessions, daily group sessions, and quarterly social events. All intervention components were designed to reduce HIV sexual risk behaviors and increase healthy transgender transition options.
The individual risk reduction counseling sessions allowed the trans peer staff to fully assess participants’ needs, make appropriate referrals and, when necessary, direct participants to a higher intensity intervention. Groups were conducted daily at 6:00 PM and a full hot meal was served prior to each group. Transitional Life Skills Groups were conducted on Mondays and provided a context for transition expression related to hair, cosmetics, clothing and hygiene. Skills-building Groups were facilitated on Tuesdays and Thursdays. The Skills-building Groups were manual-driven and the group topics included: Gender Transition Options; Entering the Work Force or Continuing Your Education; Hepatitis and Other Sexually Transmitted Infections; Hook-ups, Dating, and Escorting; Self-esteem and Transphobia; Violence Against Trans Individuals and Trans Resilience; Ending the HIV Epidemic. The Skills-building group topics were decided upon by trans women who participated in community focus groups. Open Discussion Groups were facilitated on Wednesdays and Fridays. Participants were provided a safe environment, within a high-tolerance setting, to openly discuss high-risk behaviors. HIV risk co-factors, HIV risk reduction, and health disparities such as transphobia, stigma, racism and discrimination were addressed within each group format. Quarterly social events were designed to convey health information, prevention messages, and foster social support in a festive, party-style atmosphere.
From February 2010 to December 2017, 514 transgender women enrolled in TransAction. Increased attendance in TransAction intervention sessions was associated with significant reductions in the number of male sexual partners (neg. bin. coef. = -0.20; p ≤ 0.001), anonymous male sexual partners (neg. bin. coef. = -0.30; p ≤ 0.01), exchange male sexual partners (neg. bin. coef. = -0.25; p ≤ 0.001), drug/alcohol use (logit coef. = -0.37; p ≤ 0.001), injection drug use (logit coef. = -0.20; p ≤ 0.05), unmonitored injection hormone use (logit coef. = -0.55; p ≤ 0.001), sex while under the influence of alcohol/drugs (logit coef. = -0.23; p ≤ 0.001), and engagement in sex work (logit coef. = -0.20; p ≤ 0.001). All multivariate models demonstrated a significantly good fit to the data (all χ2(6) > 25.5; p < 0.001).
Reback, C.J., Clark, K., & Fletcher, J.B. (2019). TransAction: A Homegrown, Theory-based, HIV Risk Reduction Intervention for Extremely High-risk Transgender Women Experiencing Multiple Health Disparities. Sexuality Research and Social Policy. 16(4): 408-418. DOI: 10.1007/s13178-018-0356-7 NIHMS1508593
