Abstract
This study investigates baseline differences in couples enrolled in the “It Takes Two” HIV prevention intervention for transgender women and their partners, comparing in-person participation pre-COVID-19 and digital participation during the pandemic. Among 52 couples (40% in-person, 60% digital), bivariate analyses revealed that in-person participants were more likely to be African American, have cisgender male partners, report higher unemployment, incarceration histories, greater relationship stigma, and lower relationship quality. The findings highlight the limitations of digital modalities in engaging transgender women of color and those with structural vulnerabilities. The study emphasizes that reliance on digital methods in HIV research jeopardizes the inclusion of those lacking technological access and literacy, especially communities disproportionately impacted by HIV. Researchers must incorporate hybrid or in-person options and engage communities to ensure equity and inclusion, thus overcoming barriers and ensuring comprehensive population reach in HIV prevention studies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sevelius JM, et al. Research with marginalized communities: challenges to continuity during the COVID-19 pandemic. AIDS Behav. 2020;24:2009–12.
Wirtz AL, Logie CH, Mbuagbaw L. Addressing health inequities in digital clinical trials: a review of challenges and solutions from the field of HIV research. Epidemiol Rev. 2022;44(1):87–109.
Stephenson R, et al. Project Moxie: results of a feasibility study of a telehealth intervention to increase HIV testing among binary and nonbinary transgender youth. AIDS Behav. 2020;24:1517–30.
Wirtz AL, et al. HIV incidence and mortality in transgender women in the eastern and southern USA: a multisite cohort study. Lancet HIV. 2023;10(5):e308–19.
Pinto RM, Park S. COVID-19 pandemic disrupts HIV continuum of care and prevention: implications for research and practice concerning community-based organizations and frontline providers. AIDS Behav. 2020;24:2486–9.
Rennie S, et al. HIV prevention research and COVID-19: putting ethics guidance to the test. BMC Med Ethics. 2021;22(1):1–10.
Valdez ES, Gubrium A. Shifting to virtual CBPR protocols in the time of corona virus/COVID-19. Int J Qualitative Methods. 2020;19:1609406920977315.
Gamarel KE, et al. Commitment, interpersonal stigma, and mental health in romantic relationships between transgender women and cisgender male partners. J Social Personal Relationships. 2019;36(7):2180–201.
Gamarel KE, et al. Relationship stigma and HIV risk behavior among cisgender men partnered with transgender women: the moderating role of sexual identity. Arch Sex Behav. 2020;49:175–84.
Reisner SL, et al. Unspoken agreements: perceived acceptability of couples HIV testing and counseling (CHTC) among cisgender men with transgender women partners. AIDS Behav. 2019;23:366–74.
Tabrisky AP et al. Protocol: couples-focused intervention to improve engagement in HIV care: protocol for a randomised controlled trial. BMJ open, 2021. 11(3).
Gamarel KE et al. A relationship-focused hiv prevention intervention for young sexual minority men in the United States: a pilot randomized controlled trial of the we prevent intervention. AIDS Behav, 2023: p. 1–17.
Gamarel KE, et al. Stigma experienced by transgender women of color in their dating and romantic relationships: implications for gender-based violence prevention programs. J Interpers Violence. 2022;37(9–10):NP8161–89.
Poteat T, et al. Understanding HIV risk and vulnerability among cisgender men with transgender partners. Lancet HIV. 2020;7(3):e201–8.
Operario D, et al. Couples-focused prevention program to reduce HIV risk among transgender women and their primary male partners: feasibility and promise of the couples HIV intervention program. AIDS Behav. 2017;21:2452–63.
CDC, Couples HIV Intervention Program (CHIP): Good Evidence- Risk Reduction in Compedium of Evidence-based Intervention and Best Practices for HIV Interventions. 2017.
Gamarel KE, et al. Couples-based approach to HIV prevention for transgender women and their partners: study protocol for a randomised controlled trial testing the efficacy of the ‘It takes two’intervention. BMJ open. 2020;10(10):e038723.
Spanier GB. Dyadic adjustment scale. Multi-Health Systems Toronto; 1989.
Rusbult CE, Martz JM, Agnew CR. The investment model scale: measuring commitment level, satisfaction level, quality of alternatives, and investment size. Personal Relationships. 1998;5(4):357–87.
Aron A, Aron EN, Smollan D. Inclusion of other in the self scale and the structure of interpersonal closeness. J Personal Soc Psychol. 1992;63(4):596.
Frost DM, Forrester C. Closeness discrepancies in romantic relationships: implications for relational well-being, stability, and mental health. Pers Soc Psychol Bull. 2013;39(4):456–69.
Kurdek LA. Conflict resolution styles in gay, lesbian, heterosexual nonparent, and heterosexual parent couples. J Marriage Fam, 1994: p. 705–22.
Gamarel KE, Golub SA. Sexual goals and perceptions of goal congruence in individuals’ PrEP adoption decisions: a mixed-methods study of gay and bisexual men who are in primary relationships. Ann Behav Med. 2020;54(4):237–48.
Gamarel KE, et al. Gender minority stress, mental health, and relationship quality: a dyadic investigation of transgender women and their cisgender male partners. J Fam Psychol. 2014;28(4):437.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.
Derogatis LR. Brief symptom inventory. European Journal of Psychological Assessment; 1975.
Lang AJ, et al. Abbreviated PTSD checklist (PCL) as a guide to clinical response. Gen Hosp Psychiatry. 2012;34(4):332–8.
Reisner SL, et al. It all dials back to safety’: a qualitative study of social and economic vulnerabilities among transgender women participating in HIV research in the USA. BMJ open. 2020;10(1):e029852.
Carrese-Chacra E et al. Longitudinal effects of pandemic stressors and dyadic coping on relationship satisfaction during the COVID‐19 pandemic. Family Relations, 2023.
Boshara AI, et al. Supporting retention in HIV care: comparing in-person and telehealth visits in a Chicago-based infectious disease clinic. AIDS Behav. 2022;26(8):2581–7.
Reif S, et al. The effects of the COVID-19 pandemic on organizations in the Deep South. Center for Health Policy and Inequalities Research, Duke University: Durham, NC; 2021.
Acknowledgements
The authors would like to thank the couples who participated in this study. This study was funded by a grant from the National Institute of Mental Health (R01MH115765) and the authors were in supported in part by grants from the National Institutes of Health (P2CHD041028; R25MH067127).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Conflicts of Interest
Each of the authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Gamarel, K.E., Stein, E.S., Correll-King, W.M. et al. A Cautionary Tale: Digital Clinical Trial Implementation of a Couples-Based HIV Prevention Study among Transgender Women and Their Partners in the United States. AIDS Behav 29, 37–44 (2025). https://doi.org/10.1007/s10461-024-04477-x
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1007/s10461-024-04477-x