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Psychological resilience among transfeminine adolescents and emerging adults living with HIV

Harper, Gary W.a; Wagner, Riley L.a; Popoff, Elliota; Reisner, Sari L.b; Jadwin-Cakmak, Lauraa

doi: 10.1097/QAD.0000000000002174
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Objectives: The current study sought to examine factors that promote psychological resilience related to engagement in the HIV continuum of care (CoC) among transfeminine adolescents and emerging adults (TF AEA) living with HIV in the U.S. using a qualitative approach.

Design: The parent study from which these data came utilized a concurrent transformative mixed-methods research design grounded in Gender Affirmation and Gender Minority Stress Theory that focused on advancing our understanding of transgender youth's experiences with healthcare generally and their experiences across the HIV CoC.

Methods: Semi-structured in-depth qualitative interviews with 66 TF AEA living with HIV were analysed using a two-stage interpretive phenomenological analytic approach that allowed for both inductive and deductive explorations of the data.

Results: When discussing health-promoting psychological resilience factors, participants described both interpersonal resources (i.e. support or assistance via interactions with others) and intrapersonal assets (i.e. positive internal cognitive processes) that encouraged their engagement in the HIV CoC. The interpersonal resources described by participants included three main types of support: emotional support, gender support and instrumental-informational support. Three thematic categories describe the intrapersonal assets that participants discussed: health awareness and HIV acceptance; health motivation and health responsibility; and psychological well being and inner strength.

Conclusion: Despite experiences of HIV-related stigma and transphobia, TF AEA living with HIV demonstrate psychological resilience, as they navigate engagement in the HIV CoC. Results highlight possibilities for implementing public health interventions at individual, community and systems levels to bolster resilience among TF AEA living with HIV.

aDepartment of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan

bPediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Correspondence to Gary W. Harper, PhD, MPH, Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA; E-mail: gwharper@umich.edu

Received 13 June, 2018

Revised 1 November, 2018

Accepted 11 February, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.