Transgender Women Involved in Strategies for Transformation (TWIST) is an intervention for adult transgender women with HIV. TWIST seeks to reduce sexually transmitted diseases (STDs) and HIV transmission risk behaviors among transgender women by fostering gender affirmation, self-pride, increased social support, increased HIV and STD knowledge, self-efficacy for relationship management, safer-sex practices, and stress reduction.


TWIST logo

Transgender Women Involved in Strategies for Transformation (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 three months. It consists of four 4-hour sessions, taught by two adult transgender women who are trained to deliver the intervention through attending a Training of Facilitators (TOF) course.

As an extensive adaptation of the Women Involved in Life Learning from Other Women (WILLOW) [227 KB] intervention, TWIST provides a framework for transgender women to share their lived experiences as a means of recognizing and valuing their social and cultural resilience. Intervention activities are guided by social cognitive theory, transgender theory, and gender affirmation theory. Intervention activities also include strategies that support gender identity and HIV-status disclosure.

TWIST Training

There is no CDC-supported training currently available for TWIST. Technical assistance for the implementation of TWIST is available.

To request technical assistance:

  1. CDC’s directly funded health department and CBO partners may request technical assistance by submitting a request in the CBA Tracking System.
  2. Organizations not directly funded by CDC may contact their local health department for assistance in submitting a request.

If you have questions or need additional assistance, please contact

Implementation and Marketing Materials

Materials and resources that support the implementation of TWIST are coming soon.

Key references related to TWIST are listed below.

  • Bandura A. “Social Cognitive Theory and Exercise of Control over HIV Infection.” In: DiClemente RJ, Peterson JL (eds.). Preventing AIDS: Theories and Methods of Behavioral Interventions. New York City: Plenum Press; 1994. 25-29. Print.
  • Bockting WO. “Transgender Identity Development.” In: Tolman DL, Diamond LM, Bauermeister JA, George WH, Pfaus JG, and Ward LM (Eds.). APA Handbook of Sexuality and Psychology: Vol. 1: Person-Based Approaches (pp. 739-758). Washington, DC: American Psychological Association; 2014.
  • Centers for Disease Control and Prevention (CDC), HIV/AIDS Prevention Research Synthesis Project. Compendium of HIV Prevention Interventions with Evidence of Effectiveness (revised ed.); 1999. Retrieved from CDC: HIV/AIDS Prevention Research Synthesis Project website:
  • Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. HIV and Transgender People; 2018. Retrieved from CDC HIV/AIDS website:
  • Sevelius JM, Patouhas E, Keatley JG, Johnson MO. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med 2014;47(1):5-16.
  • Sevelius JM. Gender Affirmation: A framework for conceptualizing risk behavior among transgender women of color. Sex Roles 2013;68(11-12):675-689.
  • The Well Project (2016). Trans Women Living with HIV. Retrieved from: