Transgender Women Involved in Strategies for Transformation:

A high-impact prevention (HIP) intervention for transgender women with HIV


Program Overview

TWIST is a peer-led, small-group, social-skills-building, and educational intervention for adult, transgender women with HIV, who have known their HIV status for at least 3 months. It consists of four 4-hour sessions, delivered by two adults, trained to deliver the intervention by attending a Training of Facilitators (TOF) course. Since TWIST is a peer-led intervention, it is strongly recommended that one of the transgender women facilitating TWIST is a peer who has HIV. TWIST groups consist of 8 to 10 transgender women with HIV and are conducted in community-based settings. As an extensive adaptation of the Women Involved in Life Learning from Other Women (WILLOW) intervention, TWIST seeks to reduce sexually transmitted diseases (STDs) and HIV-transmission risk behaviors among transgender women with HIV (TWH) by fostering gender affirmation, self-pride, increased social support, increased HIV and STD knowledge and self-efficacy for relationship management, safer-sex practices, and stress reduction. TWIST provides a framework for transgender women to share “their truth” of their lived experiences as a means of recognizing and valuing their social and cultural resilience. The intervention includes strategies for gender identity and HIV-status disclosure.

Core Elements

1.    Conduct small group interactive sessions that are supportive and meet the goals of the intervention.

2.    Implement TWIST with transgender women 18 years or older who have HIV, and who have known their HIV zero status for at least 90 days, in community settings.

3.    Use two skilled, adult, transgender women facilitators to implement TWIST sessions. It is strongly recommended that since TWIST is a peer-led intervention, at least one of the transgender women facilitators has HIV and is open and comfortable about disclosing her status.

4.    Use materials that are transgender women focused and culturally appropriate to foster gender affirmation, self-acceptance and self-efficacy.

5.    Train transgender women in coping, decision-making, goal setting, condom negotiation, and condom use skills, all of which are supportive of safer sexual behaviors.

6.    Discuss topics such as stigma and disclosure related to being transgender and to having HIV, self-acceptance, self-care, consistent condom use, social support networks, and STD and HIV information, to support their decision-making about enhancing quality of life, sexual health, and HIV care issues.

7.    Inform transgender women about aspects of healthy and unhealthy relationships and types of abuse as related to the negotiation of safer sexual practices and HIV self-care and treatment.

8.    Educate transgender women to be actively involved in their own HIV care, treatment and adherence, and to establish a long-term goal of living well with HIV.

9.    Use an educational and informational focus in the sessions as opposed to a counseling and service provision focus. Target Population Transgender women with HIV, who are 18 years or older and who have known their HIV status for at least 3 months. Program Materials·     

TWIST Implementation Manual·     

TWIST Facilitator’s Guide·     

TWIST Poster·     

TWIST Session Materials and Evaluation Tools More Information on TWIST

For more information about TWIST or to place your name on a list for a future training, please visit our website