A new American study published last month in Pediatrics found that trans-inclusive training for health providers, trans-inclusive comprehensive sexuality education and supportive adults may reduce the high rates of HIV transmission experienced by trans youth.

The study, Transgender Youth Experiences and Perspectives Related to HIV Preventive Services, is based on qualitative data collected through two, three-day focus groups with 30 trans youth aged 13 to 24 from across the United States. It sought to better understand the perspectives, needs and experiences of trans young people in order to create interventions that can improve the health of trans young people and reduce the risk of HIV transmission.

The study identifies two key barriers around self-efficacy in sexual decision making that trans youth experience which heightens their risk of HIV transmission: The ability to communicate effectively about sexuality and sexual health decisions with partners, as well as safety concerns and fear while navigating sexual or romantic relationships.

Participants also emphasized the need for more support and education, and for trans-affirming and culturally competent experiences when accessing schools and healthcare services.

One of the study’s authors, Dr. Holly Fontenot, an associate professor at Boston College and adjunct faculty at The Fenway Institute, says that these findings really demonstrate the importance of helping trans young people build their self-worth. “If you can really affirm youth and let them figure out their identities in the world in a positive way, then you can help them understand relationships better, how to advocate in relationships better, how to communicate in relationships better,” she says. “If you have an inherent sense of worth, you are better at advocating for your own health.”

Noah Reinoso, a trans young person, sex educator and artist based in Ottawa, emphasized just how complicated it is for many trans young people to navigate sexual and romantic relationships. “As a trans person, it can be so much more difficult to make healthier sexual decisions; keeping in mind our health and communicating our needs can be that much harder when you’re trans,” he says. “Especially when you always have to advocate for yourself.”

The study identifies three key interventions to support trans youth and reduce their risk of HIV transmission. These include increasing the capacity of adults (like parents), educators and particularly health and social service providers to be inclusive and affirming of trans young people. Addressing the broader barriers to health and social services, such as accessibility, affordability and stigma, and expanding sexual health education to be truly inclusive of diverse gender identities, sexual orientations and sexualities were also key interventions identified in the study.

Reinoso agrees that having access to a strong support system and supportive adults has made a huge difference in his life, and had a profoundly positive impact on his mental health when he first came out as trans. Reinoso, who lives with his biological mother and his step-father, found that they struggled with his coming out as trans because they didn’t understand. “My early transition was really difficult from a mental health standpoint and in terms of medical services. I had no support in navigating these services and having parents to help would’ve been huge.” When Reinoso reconnected with his biological father, who had been out of his life for a long time, he found the support he needed. “He’s a queer adult, he’s HIV positive and being able to have conversations with him that I couldn’t really have with anyone else was a huge help.”

Dr. Fontenot emphasizes how this study reinforces the need to provide better training and education to health and social service providers. “Being a supportive presence for youth, reducing stigma and discrimination ultimately helps optimize health for youth, and trans youth in particular,” she says. “These youth aren’t used to having people rally around them. Trans youth have a strong history of being and feeling marginalized. If we can change that experience, we can turn the tide for transgender kids.”

The study’s findings further cement the important role support from adults play in the lives of trans youth identified in previous research, such as findings from Trans Pulse Ontario that found that 4 percent of trans youth with very supportive parents had attempted suicide in the past year, compared to 57 percent of trans youth who had parents that were either somewhat supportive or not supportive at all. The Transgender Youth Experiences and Perspectives Related to HIV Preventive Services study also reinforces the importance of trans-inclusive sex education, which is recognized as an international best-practice based on guidelines set out by the United Nations.

“The study really highlighted how difficult it is for trans youth to find medically accurate and affirming information online,” Dr. Fontenot says. “This really shows how hard it is to get this information in person, especially if they don’t have adults who can help them get it for them.”

Reinoso says that he hopes the study will help give trans youth the physical evidence they often need to advocate for themselves; that it will help trans kids prove to their families and other adults in their lives that affirming and supporting trans kids is the best way to improve their health and well-being.

Given the need for more resources for both trans young people and the adults who support them, Dr. Fontenot and The Fenway Institute say they are committed to continuing this research and developing resources. These include a variety of webinars and other online tools to help improve access to inclusive and medically accurate information about gender identity, sexual orientation, sexuality and sexual health.

Dr. Fontenot says that the study found, more than anything else, that trans youth need supportive adults on their side. She encouraged parents, health providers and other adults to think about what they can do individually to support trans young people in their community—because all too often, trans young people feel like they are on their own.

“It’s tough, because I want to say people should just want to support their kids anyways, but obviously that’s not necessarily the case,”Reinoso says. “Hopefully with medical professionals there’s more training specific to trans needs. We [as trans people] have to do a lot of the teaching to our doctors and medical providers, and that can be incredibly frustrating.”

“Especially if you’re a young person and you don’t have the language you need to communicate correctly. Giving that knowledge to providers makes it easier on us.”