HIV infection risk factors among male-to-female transgender persons: a review of the literature.

School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA.
The Journal of the Association of Nurses in AIDS Care: JANAC (Impact Factor: 1.23). 09/2009; 20(5):362-72. DOI: 10.1016/j.jana.2009.06.005
Source: PubMed

ABSTRACT Male-to-female (MTF) transgender women experience a host of psychosocial issues such as discrimination, stigmatization, and marginalization. These challenges often limit economic opportunities, affect mental health, and may place members of this population at an increased risk for HIV infection. This report presents a review of the literature that focuses on risk factors for HIV infection specific to the MTF population. Factors including needle sharing and substance abuse, high-risk sexual behaviors, commercial sex work, health care access, lack of knowledge regarding HIV transmission, violence, stigma and discrimination, and mental health issues have been identified in the literature as risk factors for the acquisition of HIV infection by members of this population. Implications for care provided to MTF transgender persons are presented, and suggestions for future research are identified.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Recent studies in Chile provide encouraging data on the attitude of the Chilean society toward sexual minorities, although other studies reveal that new ways to express stigma and discrimination toward sexual minorities have emerged. The objective of this study was the construction and validation of a measure to describe and characterize stigma and discrimination toward the gay men and transgender women population in Chile. Two studies were conducted. In study 1, the initial version of a scale, consisting of 147 items, was constructed in a process involving three phases: (a) a theoretical phase, (b) a qualitative phase, and (c) a phase using the original version of our scale. This original version was administered to a non-probabilistic snowball-type sample of 100 gay men (pilot study). After several analyses, the items were selected for the abbreviated version of the scale (SISD). Thus, the scale finally contained 23 items in six dimensions. In study 2, the SISD was administered to a type of RDS for gay men and a non-probabilistic snowball-type sample for transgender women. This study included 437 subjects aged 18-75 years (M = 32.22, SD = 10.22), 325 gay men (74.4 %), and 112 transgender women (25.6 %). The reliability coefficient was 0.89 for the SISD. In addition, there were statistically significant differences in the SISD scores between gay men and transgender women (t ((435)) = -2.48, p < 0.05, d = 0.26). Moreover, statistically significant differences were found between gay men and transgender women in three dimensions of the scale: disadvantages in the presence of authorities (t ((435)) = -2.83, p < 0.005, d = 0.31); discrimination at work (t ((435)) = -3.78, p < 0.005, d = 0.40); and institutional exclusion (t ((434)) = -4.25, p < 0.001, d = 0.46). A high percentage of individuals from each group reported victimization and discrimination events due to their condition as gay men and transgender women. Therefore, the SISD is a reliable and valid instrument to measure stigma and discrimination toward the gay men and transgender women population in Chile.
    Sexuality Research and Social Policy: Journal of NSRC 09/2014; 11(3):187-198. DOI:10.1007/s13178-014-0150-0 · 0.72 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Few comparative data are available internationally to examine health differences by transgender identity. A barrier to monitoring the health and well-being of transgender people is the lack of inclusion of measures to assess natal sex/gender identity status in surveys. Data were from a cross-sectional anonymous online survey of members (n > 36,000) of a sexual networking website targeting men who have sex with men in Spanish- and Portuguese-speaking countries/territories in Latin America/the Caribbean, Portugal, and Spain. Natal sex/gender identity status was assessed using a two-step method (Step 1: assigned birth sex, Step 2: current gender identity). Male-to-female (MTF) and female-to-male (FTM) participants were compared to non-transgender males in age-adjusted regression models on socioeconomic status (SES) (education, income, sex work), masculine gender conformity, psychological health and well-being (lifetime suicidality, past-week depressive distress, positive self-worth, general self-rated health, gender related stressors), and sexual health (HIV-infection, past-year STIs, past-3 month unprotected anal or vaginal sex). The two-step method identified 190 transgender participants (0.54 %; 158 MTF, 32 FTM). Of the 12 health-related variables, six showed significant differences between the three groups: SES, masculine gender conformity, lifetime suicidality, depressive distress, positive self-worth, and past-year genital herpes. A two-step approach is recommended for health surveillance efforts to assess natal sex/gender identity status. Cognitive testing to formally validate assigned birth sex and current gender identity survey items in Spanish and Portuguese is encouraged.
    Archives of Sexual Behavior 07/2014; 43(8). DOI:10.1007/s10508-014-0314-2 · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BackgroundResearch on the sexual networks of transwomen is central to explaining higher HIV risk for this population. This study examined HIV risk behaviors and sexual mixing patterns of transwomen by demographic and HIV-related risk behaviors.MethodsData were obtained from a 2010 study of HIV risk for transwomen in San Francisco. Assortativity by race, partner type, HIV serostatus, and IDU across sexual networks was calculated using Newman’s assortativity coefficient (NC). Multivariable generalized estimating equations (GEE) logistic regression models were used to evaluate associations between unprotected anal intercourse with race and HIV serostatus, partner-IDU status and relationship type discordance while adjusting for the HIV status of transwomen.ResultsThere were 235 sexually active transwomen in this study, of whom 104 (44.3%) were HIV-positive and 73 (31.1%) had a history of injection drug use. Within the 575 partnerships, African American/black and Latina transwomen were the most racially assortative (NC 0.40, 95% CI 0.34-0.45, and NC 0.43, 95% CI 0.38-0.49, respectively). In partnerships where the partner’s HIV status was known (n = 309, 53.7%), most transwomen were in sexual partnerships with people of their same known serostatus (71.8%, n = 222). In multivariable analyses, unprotected anal intercourse was significantly associated with primary partners, having a sexual partner who was an injection drug user, and sexual partner seroconcordance.ConclusionsPublic health efforts to reduce transwomen’s HIV risk would likely benefit from prioritizing prevention efforts to risk reduction within IDU-discordant and primary partnerships, determining risks attributable to sexual network characteristics, and actively addressing injection drug use among transwomen.
    BMC Infectious Diseases 08/2014; 14(1):430. DOI:10.1186/1471-2334-14-430 · 2.56 Impact Factor