Intimate Partner Violence and HIV Prevention Among Transgender and Nonbinary Persons: Protocol for a Prospective Mixed Methods Cohort Study (Preprint)

BACKGROUND Transgender and nonbinary (TNB) individuals experience intimate partner violence (IPV) at twice the rates of cisgender populations. Although prior research has linked IPV to elevated HIV risk and vulnerability among TNB persons, there is limited understanding of how IPV influences key HIV prevention behaviors, such as HIV and sexually transmitted infection (STI) testing, and initiation and use of pre-exposure prophylaxis (PrEP). IPV experiences among TNB individuals are complex and diverse, varying by type, frequency, severity, power and relationship dynamics, and often intersect with systemic forms of marginalization. Additional research is needed to investigate the mechanisms linking IPV and HIV/STI outcomes and to inform effective, tailored prevention strategies. OBJECTIVE This prospective mixed methods cohort study seeks to advance understanding of the risk and resilience pathways between IPV (both perpetration and victimization) and HIV/STI-related outcomes, including engaging in condomless sex, STI acquisition, PrEP uptake, adherence, and persistence among TNB individuals experiencing IPV. METHODS This study includes two sequential phases. Phase 1 consisted of formative qualitative interviews with 32 TNB individuals with IPV experience and 10 key informants (e.g., service providers, advocates) in the United States. These interviews informed the design of a national, web-based cohort study. Phase 2 will enroll 600 HIV-negative, currently-partnered TNB participants living in the U.S. Participants will be followed for 24 months, with surveys and at-home biospecimen collection (HIV/STI testing, PrEP adherence) at baseline, 6, 12, 18, and 24 months. Brief surveys assessing changes in key variables will also be completed at 3, 9, 15, and 21 months. RESULTS Phase 1 was initiated in October 2023, with interviews conducted through October 2024 until thematic saturation was reached. Rapid qualitative analysis was completed between November 2024 and January 2025 to inform measurement selection for the Phase 2 surveys. Enrollment for Phase 2 began in February 2025 and is expected to continue through December 2025. CONCLUSIONS This study will provide essential insights into how IPV impacts HIV/STI risk and prevention practices among TNB individuals. Results will guide the development or refinement of gender-affirming, trauma-responsive, and culturally grounded IPV and HIV prevention interventions tailored to the needs of TNB communities.