# Participation in the house-ball community as a social determinant of HIV care and prevention outcomes among transgender women of color

## TL;DR

Participation in the house-ball community is linked to better HIV care and prevention outcomes among transgender women of color in New York City.

## Contribution

This study identifies house-ball participation as a social determinant influencing HIV-related health behaviors among transgender women of color.

## Key findings

- Current house-ball participation is associated with increased STI testing among HIV-positive transgender women of color.
- Current participation is linked to higher HIV testing rates among HIV-negative transgender women of color.
- Former house-ball participants are less likely to use PrEP compared to those who never participated.

## Abstract

House-ball scenes around the world have historically been a community for queer people to form chosen families and social networks and be exposed to community health campaigns. We investigated the impact of house-ball participation on HIV care and prevention outcomes among transgender women of color (TWOC) living in New York City. We asked 178 participants who identified as TWOC about their participation in the house-ball scene (never, former, current), and we asked them about their status-neutral HIV care and prevention outcomes, including HIV/STI testing, condom use, PrEP use, and HIV viral load suppression. We used Targeted Maximum Likelihood Estimation (TMLE) to estimate the adjusted relative risk of house-ball participation on these baseline outcomes; we included age, education, and US-born nativity as potential confounders. Among TWOC living with HIV (n = 94; 52.8 %), we found a positive effect of current participation in the house-ball scene on past six-month STI testing compared to never participation (Relative Risk: 1.20, 95 % CI: [1.07, 1.34]). Among TWOC not living with HIV (n = 84; 45.2 %), we found a positive effect of current participation in the house-ball scene on past six-month HIV testing (Relative Risk: 1.27, 95 % CI: [1.11, 1.44]). We found that those who formerly participated in the house-ball scene were less likely to currently use PrEP compared to those who never participated (Relative Risk: 0.44, 95 % CI: [0.23, 0.88]). Community, network connections, and exposure to health campaigns within the house-ball scene may enable and motivate individuals to achieve better HIV care and prevention outcomes.