Mixed methods trial of a peer intervention for HIV and partner victimization in transgender women

Transgender (trans) women are disproportionately impacted by adverse health outcomes compared to their cisgender counterparts, including mental health challenges, HIV and other sexually transmitted infections, and intimate partner violence (IPV). In response, we developed the Supporting Trans women, Affirmation, Relationships, and Sex (STARS) program-a peer-delivered intervention that aims to promote gender affirmation, empowerment, and HIV prevention for trans women who have experienced IPV. STARS comprises four ∼1-hr individual peer-counseling sessions delivered over 6 weeks focused on safety planning, resource referrals, and HIV prevention. We used a convergent, mixed methods, randomized controlled trial design to evaluate the program's feasibility, acceptability, and explore preliminary efficacy. Thirty-seven participants were randomly assigned to the intervention (n = 19) or a time- and attention-matched control (n = 18) and completed assessments at baseline, postintervention, and 4- and 6-month follow-up. Findings demonstrate high intervention satisfaction (M = 3.29, SD = 0.48, range [1-4]) and low attrition (5.26% at 6-month follow-up). Thematic analysis of exit interviews revealed strong qualitative endorsements of resource referrals, self-empowerment content, and peer counselor relationships. Findings from exploratory intent-to-treat analyses showed greater improvements in posttraumatic stress disorder symptoms (β = -.28; p = .019), depressive symptoms (β = -0.23; p = .037), and empowerment related to IPV safety (β = .23; p = .02) in the intervention compared to control. There were no between-group differences in instances of IPV (p = .45) or general self-efficacy (ps ≥ .39). HIV-vulnerable condomless anal sex was infrequent and insufficient to support a stable model estimation. These results provide initial empirical support for STARS as an effective intervention to improve mental health and self-empowerment outcomes among transfeminine individuals who have experienced IPV. (PsycInfo Database Record (c) 2026 APA, all rights reserved).