Transgender Women Involved in Strategies for Transformation:
A high-impact prevention (HIP) intervention for
transgender women with HIV
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 adult, 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.
- Conduct small group interactive sessions that are supportive and meet the goals of the intervention.
- Implement TWIST with transgender women 18 years or older who have HIV, and who have known their HIV serostatus for at least 90 days, in community settings.
- 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.
- Use materials that are transgender women focused and culturally appropriate to foster gender affirmation, self-acceptance and self-efficacy.
- Train transgender women in coping, decision making, goal setting, condom negotiation, and condom use skills, all of which are supportive of safer sexual behaviors.
- 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.
- 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.
- 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.
- Use an educational and informational focus in the sessions as opposed to a counseling and service provision focus.
Transgender women with HIV, who are 18 years or older and who have known their HIV serostatus for at least 3 months.
- 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 https://effectiveinterventions.cdc.gov.