Sel Hwahng

Beth Israel Medical Center, New York City, New York, United States

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Publications (24)36.92 Total impact

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    ABSTRACT: In a 3 year prospective study of 230 transgender women from the New York City Area, we further examined associations of gender-related abuse with HIV sexual risk behavior and incident HIV/STI, focusing here and the extent to which these associations are buffered by involvement in a transgender community. Largely consistent with the prior study, gender abuse was longitudinally associated with unprotected receptive anal intercourse (URAI) with casual and commercial sex partners, and the presumed biological outcome of this behavioral risk, new cases of HIV/STI. Both of these associations, gender abuse with URAI and HIV/STI, were significantly buffered by transgender community involvement (interaction effects). However, independent of these interaction effects, transgender community involvement was also positively associated with URAI and HIV/STI (direct effects). HIV prevention in this population should emphasize the benefits of interactions with transgender peers while also emphasizing the importance of resisting normative permission for HIV risk behavior from these same peers.
    AIDS and Behavior 12/2014; DOI:10.1007/s10461-014-0977-7 · 3.49 Impact Factor
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    ABSTRACT: Introduction: African American and Latina transwomen (male-to-female transgender people) have been found to have very high HIV seroprevalence nationally, and in New York City almost half are HIV positive. Transwomen of color are in the midst of an HIV epidemic, and greater knowledge and understanding about transwomen of color social networks may provide relevant information towards more effective interventions and policies. Methods: These data come from a mixed-methods study that examined low-income trans/gender-variant people of color who attended transgender support groups at harm reduction programs in New York City. The study was conducted from 2011-12, with a total N=34. The qualitative portion was derived from six focus group interviews that were audio-taped and transcribed. The quantitative portion was derived from a survey that was administered at the focus groups. Results and Discussion: 45% were Latina, 39% were Black, 55% had a high school education or less, and 46% reported living with HIV. Membership in these support groups was often drawn from already-established social networks, and support groups also strengthened supportive connections between transwomen of color. Among two of the groups there was evidence of extremely strong connections that resembled alternative kinship structures. Concerns were frequently raised over experiencing structural and interpersonal violence and possible deportation. Social support was often in the form of “thick trust” (bonding/sharing) and “thin trust” (information dissemination). Both thick and thin trust relationships may provide opportunities for expanded HIV prevention. HIV prevention, however, needs to be implemented within other serious concerns of these transwomen.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Objectives. We examined the effects of gender abuse (enacted stigma), depressive symptoms, and demographic, economic, and lifestyle factors on substance use among transgender women. Methods. We conducted a 3-year prospective study (December 2004 to September 2007) of 230 transgender women aged 19 to 59 years from the New York Metropolitan Area. Statistical techniques included generalized estimating equations with logistic and linear regression links. Results. Six-month prevalence of any substance use at baseline was 76.2%. Across assessment points, gender abuse was associated with alcohol, cannabis, cocaine, or any substance use during the previous 6 months, the number of days these substances were used during the previous month, and the number of substances used. Additional modeling associated changes in gender abuse with changes in substance use across time. Associations of gender abuse and substance use were mediated 55% by depressive symptoms. Positive associations of employment income, sex work, transgender identity, and hormone therapy with substance use were mediated 19% to 42% by gender abuse. Conclusions. Gender abuse, in conjunction with depressive symptoms, is a pervasive and moderately strong risk factor for substance use among transgender women. Improved substance abuse treatment is sorely needed for this population. (Am J Public Health. Published online ahead of print September 11, 2014: e1-e8. doi:10.2105/AJPH.2014.302106).
    American Journal of Public Health 09/2014; 104(11):e1-e8. DOI:10.2105/AJPH.2014.302106 · 4.23 Impact Factor
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    ABSTRACT: Objectives. We examined the social and interpersonal context of gender abuse and its effects on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depression among transgender women. Methods. We conducted a 3-year prospective study (2004-2007) among 230 transgender women aged 19 to 59 years from the New York City Metropolitan Area. Statistical techniques included generalized estimating equations (logistic regression). Results. We observed significant associations of psychological and physical gender abuse with major depression during follow-up. New or persistent experiences of both types of abuse were associated with 4- to 7-fold increases in the likelihood of incident major depression. Employment, transgender presentation, sex work, and hormone therapy correlated across time with psychological abuse; the latter 2 variables correlated with physical abuse. The association of psychological abuse with depression was stronger among younger than among older transgender women. Conclusions. Psychological and physical gender abuse is endemic in this population and may result from occupational success and attempts to affirm gender identity. Both types of abuse have serious mental health consequences in the form of major depression. Older transgender women have apparently developed some degree of resilience to psychological gender abuse. (Am J Public Health. Published online ahead of print December 12, 2013: e1-e8. doi:10.2105/AJPH.2013.301545).
    American Journal of Public Health 12/2013; 104(11). DOI:10.2105/AJPH.2013.301545 · 4.23 Impact Factor
  • Sel J Hwahng, Larry Nuttbrock
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    ABSTRACT: Abstract Public health research has indicated extremely high HIV seroprevalence (13-63%) among low-income transfeminine people of color of African, Latina, and Asian descent living in the U.S. This paper combines two data sets. One set is based on an ethnographic study (N=50, 120 hours of participant observation). The other set longitudinal quantitative study (baseline N=600, N=275 followed for 3 years). Transfeminine people of color are much more likely to be androphilic and at high HIV risk. A greater understanding of adolescent gender-related abuse and trauma-impacted androphilia contributes towards a holistic conceptual model of HIV risk. A theoretical model is proposed that incorporates findings from both studies and integrates sociostructural, interpersonal, and intrapsychic levels of HIV risk.
    Journal of Homosexuality 12/2013; 61(5). DOI:10.1080/00918369.2014.870439 · 0.78 Impact Factor
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    ABSTRACT: Introduction: Research suggests that the largest racial/ethnic group of trans women (male-to-female transgender people) in New York City is Latinas. HIV seroprevalence among trans Latinas have been found to be as high as 49% in New York City, and trans Latinas are at high risk for HIV infection in other parts of the U.S. as well as internationally. Despite their being at unusually high risk for HIV, very little is known about the social determinants of health among trans Latinas. Methods: These data comes from a mixed-methods study that examined low-income trans/gender-variant people of color who attended transgender support groups at harm reduction programs in New York City. The study was conducted from 2011-12, with a total N=34, in which N=21 were Latina-identified. The qualitative portion was derived from six focus group interviews that were audio-taped and transcribed. The quantitative portion was derived from a survey that was administered at the focus groups. Results and Discussion: The majority of trans Latinas were immigrants, many from Mexico, and the majority of these immigrants were undocumented. Immigrant trans Latinas had stronger bonds of social support with one another compared to more assimilated trans Latinas. This support was often in the form of thick trust (bonding/sharing) as well as thin trust (information dissemination). Immigrant trans Latinas also experienced familial rejection/social ostracization, economic exclusion, legal/deportation issues, health care exclusion, as well as high risk for victimization. High mental stress, substance use, and HIV infection were prevalent among the immigrant trans Latinas in this study.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
  • Sel J. Hwahng, Danielle Ompad
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    ABSTRACT: Background: Low-income heroin-, crack-, and cocaine-using African American and Latina women who have sex with women and men (WSWM) are an under-researched yet high-risk HIV population. HIV seroprevalence among drug-using WSW, including WSWM, ranges from 12.8% to 53% in New York City. Drug-using WSWM comprise a sizable portion of drug-using women of color and have been shown to be at higher HIV risk than drug-using women of color who have sex with men only (WSMO). Methods: A pilot study of 90-minute in-depth interviews with drug-using WSWM of color (n=10) and participant-observation (N=35) was conducted in New York City in 2011. Results: All women had experienced lifetime sexual victimization, 9/10 experienced childhood sexual abuse (CSA), with women who were involved in primary relationships with women (WPRW) experiencing the most extreme forms of CSA. Only WPRW engaged in transactional sex with men for drugs and/or money, and some partnered with men as a security blanket or front in order to pursue relationships with women on the down low. WPRW also tended to have sex with multiple male partners, drug-using men, and men who have sex with men and women. WPRW also provided specialized sexual services to men and were considered virginal and unused because of their gay status. IDU was only found among WPRW. Conclusion: Female primary relationship partners may be indicative of a sexual minority status among WSWM that results in lower socio-economic status and higher HIV risk compared to women with male partners only.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: There is a dearth of health research about transgender people. This mixed-methods study sought to formatively investigate the health and perceived health needs of female-to-male transmasculine adults. A cross-sectional quantitative needs assessment (n = 73) and qualitative open-ended input (n = 19) were conducted in June 2011. A latent class analysis modeled six binary health indicators (depression, alcohol use, current smoking, asthma, physical inactivity, overweight status) to identify clusters of presenting health issues. Four clusters of health indicators emerged: (a) depression; (b) syndemic (all indicators); (c) alcohol use, overweight status; and (d) smoking, physical inactivity, overweight status. Transphobic discrimination in health care and avoiding care were each associated with membership in the syndemic class. Qualitative themes included personal health care needs, community needs, and resilience and protective factors. Findings fill an important gap about the health of transmasculine communities, including the need for public health efforts that holistically address concomitant health concerns.
    Journal of the American Psychiatric Nurses Association 08/2013; 19(5). DOI:10.1177/1078390313500693
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    ABSTRACT: Drug-using women who have sex with women (WSW) have higher rates of HIV-related risk behaviors and experience more violence as compared to women who have sex with men only (WSMO). We explored the relationship between violence victimization, sexual risk behavior and drug use among drug-using gay/lesbian/bisexual-identified (WSW, n= 75) and heterosexual-identified WSMO (WSMO, n=221) within a majority women of color sample. A total violence victimization score was created by summing four binary variables: childhood physical and sexual abuse, and past year physical and sexual intimate partner violence. The mean violence score was 1.37 (SD=1.3, range:0-4); WSW had higher mean scores than WSMO (1.9 vs. 1.2, p<0.001) and were more likely to experience each violence type. WSW were more likely to be injection drug users (IDUs), cocaine dependent, and have alcohol problems as well as have ≥2 sex partners and risky sexual partners (individuals who were IDUs, paid/were paid for sex, and/or were HIV-positive) in the last six months. In multivariate logistic regression models controlling for age and modeling sexual identity and violence, violence (not being a WSW) was significantly and positively associated with cocaine dependence and IDU or HIV-positive sex partners. Being a WSW (not violence) was significantly and positively associated with multiple sex partners and a partner who paid/was paid for sex. Violence and being a WSW were significantly and positively associated with alcohol problems. WSW experienced more violence as compared to WSMO; both sexual identity and violence were independently associated with HIV risk. Variation in HIV risk between WSW and WSMO may be partially explained by violence victimization.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
  • Sel J. Hwahng, Maria Messina, Rivera Antonio
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    ABSTRACT: Introduction: Public health research has revealed 50% HIV seroprevalence among poverty-class/low-income transfeminine (MTF) people of color, along with vulnerabilities to substance use and depression/suicidality. Much less research has been conducted among poverty-class/low-income transmasculine (FTM) people of color, and there has been no comprehensive public health research specifically focusing on this latter population. Objective: This paper will present preliminary findings from focus groups conducted among both poverty-class/low-income transfeminine and transmasculine people of color populations. Findings on gender identities, social networks, relationships, abuse/violence, sexual behaviors, substance use, mental health, and HIV risk behaviors will be discussed. The majority of participants is or was affiliated with the Ball community and lived in poverty-class/low-income people of color neighborhoods. Methods: N=7 transfeminine persons and N=13 transmasculine persons participated in focus groups. Participant observation was also conducted among 300 poverty-class/low-income trans/gender-variant people of color. Results: Transmasculine people appeared to have slightly more access to resources compared to transfeminine persons. Gender identities appeared to be nuanced and complex. Transfeminine persons were mostly androphilic and transmasculine persons were mostly gynephilic/transgynephilic. For some participants violence was normalized, especially IPV. Substance use was also highly prevalent among some participants. Depression, suicidality, anxiety, and panic attacks were also common. HIV testing was common but some transfeminine persons engaged in unprotected sex with cis-gendered males of unknown HIV status. Participants often accessed healthcare services in Harlem and the South Bronx and preferred accessing healthcare in these socio-geographic enclaves. Conclusion: Both the social contexts of Ball-affiliation and the neighborhood context of Harlem, where the focus groups were conducted, provided a socio-geographic context that seemed very comfortable for all participants. Certain facets of resource-based social capital such as thick trust (Rostila, 2011) were integral in determining the establishment of social ties and networks and consequently where and how healthcare services were provided and accessed.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
  • Sherry Lipsky, Sel J. Hwahng
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    ABSTRACT: In contrast to lesbians, gay men, and bisexuals, trans/gender-variant individuals are defined/self-define according to their gender identity and presentation, which includes a broad spectrum of gender identity, expression, and sexual orientation. As noted in the recent IOM report, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, the evidence base for providing trans/gender-variant specific healthcare has been limited in several respects, including populations, sampling methods, and scope. A more rigorous research program is needed to understand the health implications of trans/gender-variant-specific issues. This panel will begin to address these issues from a variety of perspectives, including an exploration of gender, power and risk among men who have sex with transgender persons; a statewide community needs assessment focusing on transgender persons; a mixed methods approach to assess health behaviors and perceived healthcare needs of transmasculine adults; an online study of the role of gender identity in medical decision- making; and building clinical capacity for trans/gender-variant populations.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: Objectives. We examined gender abuse and depressive symptoms as risk factors for HIV and other sexually transmitted infections (HIV/STI) among male-to-female transgender persons (MTFs). Methods. We conducted a 3-year prospective study of factors associated with incident HIV, syphilis, hepatitis B, chlamydia, and gonorrhea among 230 MTFs from the New York Metropolitan Area. Statistical techniques included Cox proportional hazards analysis with time varying covariates. Results. Among younger MTFs (aged 19-30 years), gender abuse predicted depressive symptoms (Center for Epidemiologic Studies Depression score ≥ 20), and gender abuse combined with depressive symptoms predicted both high-risk sexual behavior (unprotected receptive anal intercourse) and incident HIV/STI. These associations were independent of socioeconomic status, ethnicity, sexual orientation, hormone therapy, and sexual reassignment surgery. Conclusions. Gender abuse is a fundamental distal risk factor for HIV/STI among younger MTFs. Interventions for younger MTFs are needed to reduce the psychological impact of gender abuse and limit the effects of this abuse on high-risk sexual behavior. Age differences in the impact of gender abuse on HIV/STI suggest the efficacy of peer-based interventions in which older MTFs teach their younger counterparts how to cope with this abuse. (Am J Public Health. Published online ahead of print June 14, 2012: e1-e8. doi:10.2105/AJPH.2011.300568).
    American Journal of Public Health 06/2012; 103(2). DOI:10.2105/AJPH.2011.300568 · 4.23 Impact Factor
  • Sel J. Hwahng
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    ABSTRACT: Introduction: Low-income cocaine-, crack-, and heroin-using WSW/M are women who have sex with women, and also have sex with men. Research has shown that these drug-using WSW/M prefer women as their relational and sexual partners, but often have sex with men out of economic necessity. Low-income drug-using WSW/M are a high-risk HIV population, with HIV seroprevalence ranging from 12.8% to 53%. In randomly selected samples of high HIV risk drug-using women, drug-using WSW/M comprise a sizable portion, and sometimes even a majority of drug-using women. Methods: This presentation is an extensive review of the literature on this population from 1992 to the present, including literature authored by the presenter based on empirical research. Results and Discussion: Several studies indicate that drug-using WSW/M are at higher HIV risk from both distal and proximal factors compared to drug-using women who have sex with men only (WSMO). Compared to drug-using WSMO, drug-using WSW/M are also much more likely to trade sex with men for drugs and/or money, and male partners of drug-using WSW/M tend to be at much more high risk, including MSM/W, IDUs, and/or HIV-positive, compared to the male partners of drug-using WSMO. Drug-using WSW/M are also considered a bridge population that can potentially infect men through sexual and IDU transmission and infect other women through IDU transmission. Drug-using WSW/M are more likely to perform active social roles compared to drug-using WSMO, which may provide economic, social, and psychological benefits to these women while also placing them at greater HIV risk. Among drug-using women, African American women are more often associated with WSW/M behavior compared to white women, and women of color comprise the majority of drug-using WSW/M. Drug-using WSW/M of color are often not accessed by conventional outreach or programs and have special needs that should be addressed.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
  • Archives of Sexual Behavior 07/2011; 40(6). DOI:10.1007/s10508-011-9815-4 · 3.53 Impact Factor
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    ABSTRACT: In a series of important but now highly controversial articles, Blanchard examined associations of sexual orientation and transvestic fetishism among male-to-female (MTF) transgender persons in Toronto, Canada. Transvestic fetishism was rare among the homosexuals but prevalent among the non-homosexuals. Subtypes of non-homosexual MTFs (heterosexual, bisexual, and asexual) were consistently high with regard to transvestic fetishism. Non-linear associations of a continuous measurement of sexual attraction to women (gynephilia) and transvestic fetishism were interpreted in terms of an etiological hypothesis in which transvestic fetishism interferes with the early development of heterosexuality. Blanchard concluded that homosexual versus non-homosexual sexual orientation is a dominant and etiologically significant axis for evaluating and understanding this population. We further assessed these findings among 571 MTFs from the New York City metropolitan area. Using the Life Chart Interview, multiple measurements of transvestic fetishism were obtained and classified as lifetime, lifecourse persistent, adolescent limited, and adult onset. Large (but not deterministic) differences in lifetime, lifecourse persistent, and adolescent limited transvestic fetishism were found between the homosexuals and non-homosexuals. Contrary to Blanchard, differences in transvestic fetishism were observed across subtypes of the non-homosexuals, and linear (not curvilinear) associations were found along a continuous measurement of gynephilia and transvestic fetishism. Age and ethnicity, in addition to sexual orientation, were found to be statistically significant predictors of transvestic fetishism. The clinical, etiological, and sociopolitical implications of these findings are discussed.
    Archives of Sexual Behavior 04/2011; 40(2):247-57. DOI:10.1007/s10508-009-9579-2 · 3.53 Impact Factor
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    ABSTRACT: Previous research has suggested that multiple stressors may work in tandem to affect the health of women who have sex with women (WSWs). WSWs have been a part of the HIV epidemic in New York City since the beginning, making it an ideal setting to further explore these women's risk. Among a sample of 375 heroin, crack and/or cocaine using women recruited from economically disadvantaged communities in New York City, we examined HIV seroprevalence and risk behaviors among WSWs as compared to women who have sex with men only (WSMOs). We also explore differences between WSWs and WSMOs with respect to potential stressors (i.e., decreased access to resources and health care utilization and violence victimization) that might contribute overall HIV risk. The study's limitations are noted.
    Substance Use &amp Misuse 01/2011; 46(2-3):274-84. DOI:10.3109/10826084.2011.523284 · 1.23 Impact Factor
  • Archives of Sexual Behavior 10/2010; 39(5):1017-20. DOI:10.1007/s10508-010-9638-8 · 3.53 Impact Factor
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    ABSTRACT: Lesbian and bisexual women experience health inequalities compared to heterosexual women. We explored potential health and social inequalities among heroin, crack and/or cocaine users, comparing women who have sex with women (WSWs, n=133) and women who have sex with men only (WSMOs, n=242). Data were collected as part of a cross-sectional study of NYC neighborhoods. Participants were predominantly Hispanic (44.3%) or Black (40.0%); most had not completed high school (58.7%). WSWs were more likely to be homeless, have an illegal income source and incarceration history as compared to WSMOs. WSWs were significantly less likely to have public assistance and health insurance. There were no significant differences in HIV, HBV or HCV seroprevalence. WSWs were more likely to be cocaine (p=0.002) and crack dependent (p=0.06) and were younger at first sexual intercourse, had a greater number of recent sex partners, and were more likely to have traded sex and to report a recent MSM sexual partner. WSWs were also more likely to report having been shot as compared to WSMOs. Our findings suggest that drug-using WSWs experience multiple stressors (i.e., fewer resources and more violence). Multiple jeopardy and multiple minority stress may be salient concepts here; drug-using WSWs are members of multiple communities (i.e., women, LGBTQ, ethnic, drug-using, and/or poor communities) which may experience stress related to social position, discrimination, lack of cultural competency, etc. Research is needed to understand if/how these stressors work to produce health inequalities. Targeted, culturally-competent interventions are warranted to address the complex needs of this population.
    137st APHA Annual Meeting and Exposition 2009; 11/2009
  • Sel J. Hwahng, Alison J. Lin
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    ABSTRACT: Background/Significance: Most Asian Americans occupy the middle stratum within a tri-racial stratification system in U.S. mainstream society. Many male-born gender-variant and transgender people, however, may actually occupy the lowest stratum within this racial stratification system because of several factors such as transphobia, poverty, and immigration. Many Asian American male-born gender-variant and transgender people thus experience the multiple jeopardy of racism, transphobia, poverty, and immigration. Stressors arising from this multiple jeopardy may result in negative health outcomes, possibly creating health disparities that extend beyond individual behaviors. Objective/Purpose: To review the most current literature on the health of Asian American gender-variant and transgender people. Methods: Utilizing available literature and reports on Asian American gender-variant and transgender health in combination with theories relating to gender, sexuality, and race, trends in the literature relating to HIV and STIs, sexual behavior, mental health, and substance use will be discussed. Results: Studies conducted in San Francisco, New York City, Los Angeles, and other locales indicate varying results for sexual behavior, HIV seroprevalence, mental health, and substance use. Discussion/Conclusion: It is crucial to examine the social and cultural factors that interact with health behaviors, such as the persistent stressors of racism, transphobia, poverty, immigration, and multiple jeopardy. Implications for improving policy, programs, and research to address the needs of Asian American gender-variant and transgender people are explicated.
    137st APHA Annual Meeting and Exposition 2009; 11/2009
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    ABSTRACT: To describe and evaluate risk factors for HIV/sexually transmitted infections (STIs) among male-to-female (MTF) transgender persons. Using the life chart interview, potential lifetime risk factors for HIV/STIs among MTFs were measured and evaluated in conjunction with lifetime exposures for HIV, syphilis, hepatitis B, and hepatitis C. The participants were 517 MTFs between the ages of 19 and 59 years from the New York metropolitan area. HIV/STIs were low among white Americans and very high among Hispanics and African Americans. In the latter groups, HIV and hepatitis B were associated with an androphilic sexual orientation, lifetime number of commercial sex partners (sex work), and the social expression of transgender identity; syphilis was associated with lifetime number of casual sex partners; and hepatitis C was associated with injection drug use, unemployment, and social expression of transgender identity. In multivariate models, the social expression of transgender identity was the strongest and most consistent predictor of HIV/STIs. Consistent with their lower levels of infections, white Americans reported significantly lower levels of the risk factors found to be predictive of HIV/STI among Hispanics and African Americans. HIV/STI prevention in this population should be targeted at Hispanic and African Americans. Prevention programs should incorporate multiple components designed to address the diverse issues confronting ethnic minority transgender persons, with an emphasis on the social expression of transgender identity.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 07/2009; 52(3):417-21. DOI:10.1097/QAI.0b013e3181ab6ed8 · 4.39 Impact Factor

Publication Stats

213 Citations
36.92 Total Impact Points

Institutions

  • 2012–2014
    • Beth Israel Medical Center
      New York City, New York, United States
  • 2008–2014
    • Columbia University
      • Center for the Study of Ethnicity and Race
      New York, New York, United States
  • 2008–2012
    • National Development and Research Institutes, Inc.
      New York, New York, United States
  • 2011
    • New York Academy of Medicine
      New York City, New York, United States