HIV Risk and Social Networks Among Male-to-Female Transgender Sex Workers in Boston, Massachusetts

The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.
The Journal of the Association of Nurses in AIDS Care: JANAC (Impact Factor: 1.27). 09/2009; 20(5):373-86. DOI: 10.1016/j.jana.2009.06.003
Source: PubMed


Male-to-female transgender individuals who engage in sex work constitute a group at high risk for HIV infection in the United States. This mixed-methods formative study examined sexual risk among preoperative transgender male-to-female sex workers (N =11) in Boston. More than one third of the participants were HIV-infected and reported a history of sexually transmitted diseases. Participants had a mean of 36 (SD =72) transactional male sex partners in the past 12 months, and a majority reported at least one episode of unprotected anal sex. Qualitative themes included (a) sexual risk, (b) motivations for engaging in sex work, (c) consequences of sex work, (d) social networks (i.e., "trans mothers," who played a pivotal role in initiation into sex work), and (e) potential intervention strategies. Results suggest that interventions with transgender male-to-female sex workers must be at multiple levels and address the psychosocial and environmental contexts in which sexual risk behavior occurs.

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    • "Some transwomen report that receptivity during sex is experienced as affirming of their female gender identity (Bockting et al. 1998), and since very few transwomen have access to (and many do not desire) genital surgery, receptivity during sex for transwomen usually means receptive anal sex (Nuttbrock et al. 2009b). In addition , studies have shown that experiences of stigma and discrimination increase transwomen's need for gender affirmation from their male sexual partners, thus increasing their willingness to engage in risky sexual behavior and reducing their self-efficacy to negotiate condom use and/or substance use during sex (Bockting et al. 1998; Melendez and Pinto 2007; Reisner et al. 2009; Rodriguez-Madera and Toro- Alfonso 2005; Sausa et al. 2007; Sugano et al. 2006). One meta-analysis found that almost half (44 %) of transwomen reported unprotected receptive anal intercourse, with the highest rates being reported with sex work clients (39 %) and primary partners (37 %) (Herbst et al. 2008). "
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