Promising model for improving health for transgender women in Lebanon

Transgender women are 49 times more likely to become HIV positive than all adults of reproductive age worldwide. They often face stigma and violence and thus are at higher risk for poor mental health due to high rates of sex work, unprotected sex and substance use. Despite the pressing need for help, there is a dearth of evidence-based approaches specifically developed for them.

Transgender women’s risk factors are particularly understudied and invisible in the Middle East and North Africa, and effective and culturally appropriate support is urgently needed. Rachel Kaplan, PhD, MPH, and colleagues aim to address this gap with the first ever study to tackle HIV prevention among transgender women in Lebanon.

Adapting an existing model, the program locally known as Baynetna used peer recruiters from within the transgender community. Participants attended weekly 3-hour trans-facilitated group sessions for 6 weeks. A trans woman was trained to facilitate the group sessions, focusing on topics like self-esteem and transphobia or HIV and other STIs. Participants also had one-on-one assessments and everyone shared a hot meal at the end of each session. Group members received a certificate of achievement during a celebratory ceremony at the end of the program. The goal of the program was to increase community connectedness and social cohesion, thereby improving sexual and mental health.

Overall, participants ranked all aspects of the program highly, demonstrating that it’s feasible to implement and acceptable to trans women in Lebanon. Timing the sessions to accommodate their schedules was key. It was also important to have a safe and accessible venue—the organization chosen was on a main thoroughfare and did not have any nearby police/state security checkpoints. Most women felt they had the right amount of time to express themselves and to cover all the topics. They also rated the facilitator very highly for her attentiveness, mastery of topics and communication skills. The retention rate throughout the 6 weeks was an impressive 94%.

The women described feeling less alone because of their engagement with Baynetna. Many women were sad when the program was over and wanted to spend more time together. “Every Monday I learn something new. Every person is a lesson,” said one participant. Another noted, “I realized today that I have self-confidence and it encouraged me to keep pushing forward.”

This pilot has shown for the first time that a trans-facilitated group support model for HIV prevention can be adapted for Lebanon. It holds great promise for scaling up to assess how it impacts mental and sexual health on a larger scale.