Transgender women (assigned 'male' at birth with a female identity) are an understudied group with HIV prevalence rates in the range of 22 to 68%. Public health intervention research has produced no theory- driven, evidence-based interventions for transgender women. The unique cultural context of transgender women creates distinct risk factors that require systematic investigation and then integration into culturally elevant, community-based approaches to intervention. This K08 application describes a comprehensive, ntegrated training and research plan designed to serve as a pathway to scientific independence and the expertise to develop and test an innovative and urgently needed intervention to improve health outcomes among a highly marginalized population disproportionately affected by the HIV epidemic. The following raining objectives are proposed: (1) to acquire expertise in the evaluation and application of theories of behavior change to marginalized populations; (2) to enhance skills in the use of mixed methods data collection and analysis, with an emphasis on techniques relevant to measurement development and theory testing; (3) to gain knowledge and experience with clinical trials methodology, including issues of sampling, randomization, design, protocol development, and ethics; and (4) to obtain training and experience in methods for developing, implementing, and evaluating culturally grounded, theory-driven HIV prevention interventions for transgender women. The specific research aims of the mentored original research are: (1) to describe the role of transgender women's unique cultural context on their HIV-related risk and protective factors; (2) to create new and to adapt existing quantitative measures to more accuratelyassess psychosocial dimensions and behavior relevant to transgender women's HIV risk and protective factors; (3) to identify psychosocial factors associatedwith HIV-related sexual and injection risk behaviors and protective factors among transgender women; and (4) to develop and test the feasibility and acceptability of a theory- driven, culturally grounded HIV prevention intervention for transgender women.

Transgender women (assigned 'male' at birth but identify as female) are an understudied and highly vulnerable group, with HIV prevalence rates in the range of 22 to 68%. Due to stigma and discrimination, they may seek affirmation in ways that increase risk. This project seeks to investigate unique risk factors to develop a culturally relevant HIV prevention intervention for these high-risk women.