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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    • "Due to their expressed gender identity, young transgender women are often rejected by their families and communities and forced to strike out on their own (Garofalo et al., 2006). Social marginalization can lead directly to disproportionate homelessness and unemployment, which may then lead to illegal means of securing income and housing (e.g.,Galea & Vlahov, 2002;Link & Phelan, 1996;Reisner et al., 2009), such as sex work, drug dealing, and petty theft or credit card fraud. Importantly, socially marginalized communities also bear a disproportionate burden of negative health outcomes on a population-level in the U.S. "
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    ABSTRACT: ABSTRACT Background: Limited national data document the prevalence of incarceration among transgender women, experiences of victimization while incarcerated, and associations of transgender status with health. Methods: Data were from the National Transgender Discrimination Survey (NTDS), a large convenience sample of transgender adults in the U.S., collected between September 2008 and March 2009. Respondents who indicated a transfeminine gender identity were included in the current study (n=3,878). Multivariable logistic regression was used to model ever being incarcerated and experiencing victimization while incarcerated as a function of race/ethnicity and health-related indicators. Results: Overall, 19.3% reported having ever been incarcerated. Black and Native American/Alaskan Native transgender women were more likely to report a history of incarceration than White (non-Hispanic) respondents, and those with a history of incarceration were more likely to report negative health-related indicators, including self-reporting as HIV-positive. Among previously incarcerated respondents, 47.0% reported victimization while incarcerated. Black, Latina, and mixed race transgender women were more likely to report experiences of victimization while incarcerated. Conclusion: Transgender women reported disproportionately high rates of incarceration and victimization while incarcerated, as well as associated negative health-related indicators. Interventions and policy changes are needed to support transgender women while incarcerated and upon release.
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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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    ABSTRACT: Experiences of stigma, discrimination, and violence as well as extreme health disparities and high rates of sexual risk behavior and substance use have been well-documented among transgender women of color. Using an intersectional approach and integrating prominent theories from stigma, eating disorders, and HIV-related research, this article offers a new framework for conceptualizing risk behavior among transgender women of color, specifically sexual risk behavior and risky body modification practices. This framework is centered on the concept of 'gender affirmation,' the process by which individuals are affirmed in their gender identity through social interactions. Qualitative data from 22 interviews with transgender women of color from the San Francisco Bay Area in the United States are analyzed and discussed in the context of the gender affirmation framework.
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    ABSTRACT: The sexual health of transmen--individuals born or assigned female at birth and who identify as male--remains understudied. Given the increasing rates of HIV and sexually transmitted diseases (STDs) among gay and bisexual men in the United States, understanding the sexual practices of transmen who have sex with men (TMSM) may be particularly important to promote sexual health or develop focused HIV prevention interventions. Between May and September 2009, 16 transmen who reported sexual behavior with nontransgender men completed a qualitative interview and a brief interviewer-administered survey. Interviews were conducted until redundancy in responses was achieved. Participants (mean age, 32.5, standard deviation [SD] = 11.1; 87.5% white; 75.0% "queer") perceived themselves at moderately high risk for HIV and STDs, although 43.8% reported unprotected sex with an unknown HIV serostatus nontransgender male partner in the past 12 months. The majority (62.5%) had used the Internet to meet sexual partners and "hook-up" with an anonymous nontransgender male sex partner in the past year. A lifetime STD history was reported by 37.5%; 25.0% had not been tested for HIV in the prior 2 years; 31.1% had not received gynecological care (including STD screening) in the prior 12 months. Integrating sexual health information "by and for" transgender men into other healthcare services, involving peer support, addressing mood and psychological wellbeing such as depression and anxiety, Internet-delivered information for transmen and their sexual partners, and training for health care providers were seen as important aspects of HIV and STD prevention intervention design and delivery for this population. "Embodied scripting" is proposed as a theoretical framework to understand sexual health among transgender populations and examining transgender sexual health from a life course perspective is suggested.
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