HIV Center logo

LGBT Health

LGBT-related areas of research


Identity Development, Risk, and Resilience among Gender Diverse Populations
(Project AFFIRM)

Walter O. Bockting, Ph.D., Principal Investigator


Previous research has found that the vast majority of transgender individuals experienced discrimination and documented health inequities. Much of the data, however, is limited by the use of small convenience samples of transgender women with a history of sex work, recruited from AIDS and social service agencies. The goal of this study is to move beyond these limitations by using purposive, venue-based sampling to recruit a broad, diverse sample of transgender people in 3 U.S. cities--New York, San Francisco, and Atlanta-and enroll them into a mixed-method longitudinal study to test an adaptation of the minority stress model, investigating vulnerability, risk and resilience in the context of identity development. The aims of the study are: (1) To describe the process of transgender identity development based on qualitative lifeline interviews with a sample of 90 transgender individuals ages 16 and older, and identify periods of acute vulnerability and characteristics of resilience; (2) Informed by findings from Aim 1, to refine a model combining identity development, minority stress, and resilience, and to develop/adapt measures to assess the model's key constructs; (3) To test the model of resilience in a cohort of transgender individuals (N = 480) stratified by city, gender, and age, and follow them over time (baseline, 1-, 2-, and 3-year follow up interviews); and (4) To triangulate qualitative and quantitative data on identity development and minority stress processes in order to inform the future development and testing of intervention strategies aimed at fostering resilience and reducing stigma and discrimination. By achieving these aims, this study will make a significant advance in scientific knowledge about gender identity development, minority stress processes (enacted stigma, felts stigma, concealment, shame and their impact on health and psychosocial adjustment), minority coping (on an individual as well as community level), and the development of resilience over time. The study is innovative in its focus on an understudied minority population, the application of the lifeline interview method to this population, and the adaptation and testing of the minority stress model within the context of transgender identity development.


Visit the Project AFFIRM website.


The work of Project AFFIRM receives community input from advisory boards in all three cities. To learn more about our advisors in New York, click here.



Elder LGBT Interprofessional Collaborative Care Program (e-linc)
PI: Jeffrey Kwong, D.N.P., M.P.H; Co-Investigator: Walter Bockting, Ph.D.

The Elder LGBT Interprofessional Collaborative Care Program (e-linc) isan evidence-based, culturally appropriate interprofessional collaborative practice (IPCP) model designed to meet the health needs of older lesbian, gay, bisexual, and transgender (LGBT) adults in New York City. E-linc is an innovative, multi-component program that includes: a health and wellness component, a community and transitional care component, and a primary care and mental health component. The program is creating a practice environment that highlights the value of team-based care and collaborative problem-solving to address the needs of an underserved population. The E-linc Program will serve a critical role by providing preventive and direct care services to those in need, and will assist in the coordination of care for a vulnerable and often invisible population. The intent of this program is to address the needs of older LGBT adults throughout the aging continuum. This IPCP program will also serve as a mechanism to prepare nursing and other health professional students and residents in both interprofessional collaborative practice as well as LGBT culturally competent care.


Visit the e-linc website.


To read more about the E-LINC Program, please click here.



Social Convoys and Successful Aging among Lesbian and Gay Older Adults

(PI:Walter Bockting, Ph.D.; Co-Investigator: Anke A. Ehrhardt, Ph.D.)

The first generation of openly LGBT-identified people is entering later life, yet little is known about their needs for care and support or about the nature of the social support available and utilized by lesbian and gay elders. The goal of this two-year pilot study is to begin an in-depth examination of the social support and caregiving networks of lesbian and gay older adults to better understand their needs, as well as to illuminate the role of selective kin or families of choice and other supports in successful aging potentially relevant to other populations. This examination will be guided by the Convoy Model, according to which social relationships (or "convoys") are shaped over time and vary in their closeness, quality, function, and structure. Convoys are influenced by personal and situational characteristics, and affect health. We are systematically assessing the social convoys of lesbian and gay older adults using a well-established standardized tool, and compare these convoys to those of heterosexual controls. In addition to advancing knowledge about the role of kinship and social support in successful aging, findings will inform the development of interventions to reduce health disparities and promote quality of life among lesbian/gay and other elders.



Improving Life Trajectories for Youth with Early Psychosis
Anke A. Ehrhardt, Ph.D., Walter O. Bockting, Ph.D. (PI: Lisa Dixon, M.D.)


The goal of this project is to establish community outreach efforts for youth with early psychosis (indicative of emerging schizophrenia), who will be will be identified and connected with evidence-based treatment. Shortening the duration of untreated psychosis reduces disability so often associated with schizophrenia by helping youth stay on-track with respect to school/work, relationships, and health. Two new teams will be added to New York’s OnTrackNY initiative to provide evidence-based Coordinated Specialty Care (CSC) to youth with early psychosis. OnTrackNY uses a Critical Time Intervention model to provide, over the course of about 2 years, emotional and practical support while strengthening youths’ ties to treatment, family and friends during the critical period of early psychosis.  Drs. Bockting and Ehrhardt are lending their expertise to build capacity to reach out to LGBT youth with early psychosis, assess and respond to their specific needs, and strengthen the factors of resilience identified in empirical research. This includes development of tailored outreach materials; training in LGBT cultural and clinical competence for providers, staff, and referral networks; education for youth, families, and schools; and support for youth’s identity development. Clinicians affiliated with the LGBT Health Initiative are also available for consultation and liaison, including in the highly specialized area of transgender health.


U.S. Transgender Population Health Survey (TransPop)

Walter Bockting, Ph.D. (PI: Ilan Meyer, Ph.D.)


TransPop Study, a first-of-its-kind U.S. transgender population health survey, is being conducted by researchers at the Williams Institute at UCLA School of Law, Columbia University, Harvard University, and The Fenway Institute at Fenway Health. The study will be the first national probability sample of transgender individuals in the U.S. and thus will be provide a more accurate and detailed picture of the issues faced by transgender people. The study will provide researchers and policy makers with unbiased estimates about demographics, health outcomes and well-being, and health care needs of the transgender population, which will be crucial for designing evidence-based public health and policy interventions. 


The TransPop study aims to:

°Describe demographic parameters of the U.S. transgender population, such as race/ethnicity, age, gender identity, education, employment, etc.
°Describe basic health outcomes and health behaviors, such as health status, health care access, quality of life, etc.
°Describe experiences of transgender people with interpersonal and institutional discrimination in areas such as healthcare, employment, housing, etc.
°Describe transgender identity history and transition-related experiences.


Visit the TransPop website.


“Lesbian Mother and Gay Father Families Formed Through Assisted Reproductive Technologies: Parenting and Child Development”

Anke A. Ehrhardt, Ph.D. (PI: Susan Golombok, Ph.D.)


In collaboration with the Centre for Family Research at the University of Cambridge (U.K.) and funded by the Wellcome Trust, this research project is focused on obtaining empirical data on the psychological consequences for children being born to gay fathers through surrogacy and egg donation. The focus of this research will be on the quality of father-child relationships and thepsychological development of the child. This will be studied in comparison to lesbian and heterosexual parents who have used assisted reproduction. The findings of this study will increase theoretical understanding of the mechanisms through which parenting influences child development, particularly in relation to parental gender, parental sexual orientation, and genetic and gestational connectedness between the parents and the child, and will also inform policy and legislation in relation to this emerging family form.


To read more about this study, click here.





WICER Study: Washington Heights and Inwood Informatics Infrastructure for Community-Centered Comparative Effectiveness Research 

Walter O.Bockting, Ph.D., Faculty Investigator


WICER is a multidisciplinary research project to study the causes of disease and to compare the different methods of preventing, diagnosing and treating health conditions (also known as comparative effectiveness research) through the use of a community-focused data infrastructure. WICER is funded by the Agency for Healthcare Research and Quality (AHRQ). its goals include: to establish a comprehensive understanding of the population served by New York Presbyterian Hospital and the Columbia University Medical Centerin in five ZIP Codes (10031, 10032, 10033, 10034, 10040); to identify significant issues in health care disparities and to facilitate research with this population; and demonstrate infrastructure capabilities to support Columbia University researchers.  Dr. Bockting works with a team of faculty and students to assess health disparities among LGBT and ethnic/racial minority populations, making use of innovative information technology approaches. This includes linking data from a community survey to the electronic health record data base of Presbyterian Hospital and its partners.



Staphylococcal skin and soft tissue infections in MSM: Risk factors and US-wide
molecular epidemiology with an internet-based randomized OTC intervention

Walter O. Bockting, Ph.D. (PI: Rachel J. Gordon, MD, MPH)


Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) are a major public health issue and appear to disproportionately affect men who have sex with men (MSM). The ultimate aim of this project is to use web-based tools to better understand and identify risk factors for SSTIs in MSM nationwide and to design an intervention that includes a web-based educational component and over-the-counter (OTC) decolonization strategy to prevent recurrent SSTIs in this population. In order to achieve this goal, this study will 1) research and identify appropriate validated survey tools and methods to both qualitatively and quantitatively
assess risk for SSTIs, 2) understand what online and offline health information resources MSM use to learn about MRSA prevention and identify acceptable prevention measures, 3) study the potential stigma and psychosocial impact associated with CA-MRSA and MSM and how this may affect health risk behaviors, and 4) map the distribution of antibiotic resistance and strains of S. aureus (including CA-MRSA) colonizing and infecting our study population This work will inform the development of an internet-based educational and self-administered OTC intervention.




Injection Practices and HIV Risk Behavior among Transgendered Persons in Puerto Rico

Walter O. Bockting, Ph.D. (PI: Mark Padilla)


HIV/AIDS continues to affect the Latino community disproportionately, with more than 200,000 cases in the US attributed to this population. Puerto Ricans living on the Caribbean island have among the highest prevalence rates of HIV among Latinos, a pattern that is closely connected to the large and growing injecting drug epidemic in Puerto Rico. While intravenous drug injection practices have been studied in Puerto Rico, certain vulnerable populations and injection practices have been largely neglected. This proposal focuses on male-to-female transgendered persons (MTF-TG), who are generally absent from the scientific literature generated in Puerto Rico, and are at high risk of HIV infection. In addition to the fact that MTF-TG are embedded in an HIV epidemic that is mostly driven by injecting drug use, our preliminary studies show that they engage in body modification practices involving the use of illegal market hormone and silicone injections. Our community partners, who are conducting the only HIV prevention intervention with MTF-TG, indicate that members of this population often engage in self-injection practices during "pumping parties" for the purpose of body modification, as well as during drug use. These practices have not been scientifically studied, nor are there focused descriptive studies of the social context, meanings, and practices of injection in this population. Therefore this study aims to: (1) identify the meanings and practices of drug and hormone injection in the transgendered community in Puerto Rico; (2) describe and map the social contexts of drug and hormone injection in this population; and (3) document the relationship between drug, hormone, and silicone injection practices and risk for HIV in Puerto Rico.




Project SHAKTI: Stigma Reduction, Health Care Provider Awareness & Knowledge Enhancement on Transgender Issues, India

Walter O. Bockting, Ph.D., Investigator

HIV prevalence is disproportionately high among Male-to-female transgenders (Hijra) in India. Stigma among health care providers limits HIV testing, treatment and care and creates a barrier to HIV protective behavior. Stigmatization of transgender by healthcare providers has been documented, and is identified as a significant barrier to effective HIV prevention responses among this marginalized, at-risk population in India. However, evidence based interventions to reduce stigma and discrimination among health care providers are seriously lacking. This project is developing a theory-based, culturally relevant stigma -reducing intervention targeting health care providers in Mumbai, India. The proposed multidisciplinary US-India collaborative research team with significant HIV/AIDS research experience will implement a two-year formative study (R21) to develop and pilot health-care provider-focused stigma reducing intervention. The study has three specific aims: 1) Document cause and manifestation of stigma among health care providers in Mumbai; 2) Use the information to design a provider-focused intervention module, and obtain community feedback; 3) Pilot the revised intervention module among 50 healthcare providers, and assess its feasibility, acceptability and preliminary effect on health service behavior among healthcare providers. These data will prepare the team to conduct a large scale randomized controlled trial in India.





Health Empowerment for MSM in South Africa

Theo Sandfort, Ph.D. (PI: Tim Lane, Ph.D.)


Microbicide Safety and Acceptability in Young Men

Alex Carballo-Diéguez, Ph.D.


Rapid HIV Home Test and Decision-Making Among HIV-Negative Men
Alex Carballo-Diéguez, Ph.D.