CDC Recognizes Nathalie Tirado’s Work to Translate TWIST Intervention Tool into Spanish


The HIV epidemic is a critical public health issue in the Latino community. Fortunately, antiretroviral therapy (ART) preserves the health, quality of life, and life expectancy of people living with HIV. Moreover, people living with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative sexual partners. This is also known as being undetectable equal untransmittable — meaning the amount of HIV in the body is so low it cannot be detected. This is key for people living with HIV so they can remain healthy, enjoy an improved quality of life, and live longer.

The HIV Care Continuum involves several steps essential toward achieving viral suppression. Specifically it includes, diagnosis, linkage to care, receiving medical care for HIV infection, and achieving viral suppression. These developments have transformed the nation’s approach to HIV prevention, but we have a long way to go still. By ensuring everyone is aware of HIV, and those with HIV aware of their infections, Latinx, African American, and other minorities, have yet to access culturally competent information. When information on treatment options, viral suppression, and high-impact HIV prevention strategy is available across the board in Spanish and English – then we can sharply reduce new infections in the United States. 

With respect to the Transgender community, a community of wellness approach that understands gender dysphoria and risk for HIV are related creates a space for successful strategies.

Evidence-based interventions such as TWIST must also include a culturally defined qualitative assessment that addresses the unique factors that young transgender women of color experience. The Puerto Rican Cultural Center and the Centers for Disease Control and Prevention (CDC) have been working hand in hand developing culturally competent and inclusive high-impact interventions in Spanish. In 2018, PRCC Associate Director Nathalie Tirado successfully translated a key and trans-inclusive tool used by the CDC into Spanish, “Personalized Cognitive Counseling, an evidence-based intervention to reduce HIV-risk”. This pioneering work has helped PRCC staff deepen their understanding of critical issues that grip the trans community, such as gender dysphoria, and how a meaningful intervention strategy can reduce significant risk behaviors related to sex and substance abuse. Tirado fervently advocates for high-impact interventions to be inclusive of cultural factors such as language. Specifically, she has challenged the CDC to create materials in the Spanish language because her community in Humboldt Park as well as the Trans/Non-Binary community are not confined to the English language. 

Soon after her essential translation was approved, Tirado became the first cis-gender woman to become certified for TWIST intervention by the CDC. Transgender Women Involved in Strategies for Transformation (TWIST) is an intervention for adult transgender women with HIV (TWH). TWIST seeks to reduce sexually transmitted diseases (STDs) and HIV transmission risk behaviors among TWH 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. In 2019, Tirado witnessed firsthand the necessity for TWIST intervention in Spanish because several Spanish speaking participants could not follow nor fully participate in the training. Tirado began translating materials until the COVID-19 pandemic took hold in early 2020. During the COVID-19 pandemic Stay at Home order, Tirado spent much of her time translating the high-impact intervention into Spanish and submitted it to the CDC.

The CDC Project Officer communicated to The PRCC, “The Centers for Disease Control and Prevention is delighted with the continued contribution of The Puerto Rican Cultural Center (PRCC) commitment to improving cultural competence and providing everyone equal access to quality HIV prevention and care by translating the TWIST intervention. By providing culturally and linguistically appropriate services in health and healthcare, PRCC has improved the quality of services provided to all individuals in Chicago and the nation which ultimately helps reduce health disparities and achieve health equity.”

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