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Social Stigma, Marginalization, Injection Drug Use, and HIV Risk Among MTF Transgenders

Social Stigma, Marginalization, Injection Drug Use, and HIV Risk Among MTF Transgenders. JoAnne G. Keatley, MSW Project Director. UCSF/CAPS Health Studies for People of Color. 1145 Bush Street, 2nd Floor. San Francisco, CA 94109. High Risk.

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Social Stigma, Marginalization, Injection Drug Use, and HIV Risk Among MTF Transgenders

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  1. Social Stigma, Marginalization, Injection Drug Use, and HIV Risk Among MTF Transgenders JoAnne G. Keatley, MSW Project Director UCSF/CAPS Health Studies for People of Color 1145 Bush Street, 2nd Floor San Francisco, CA 94109

  2. High Risk Because of their unique social context, male-to-female transgenders (MTF TGs) are at high risk for HIV infection and other adverse health outcomes.

  3. Social Stigma Due to the social stigma attached to being transgender and the lack of employment opportunities, many feel forced to engage in commercial sex work.

  4. Substance Use Substance use is also quite prevalent in this population, and helps MTF TGs cope with their oppressive environment.

  5. Unprotected Sex • with commercial sex partners, who will often pay more to have unprotected sex. • with private partners who they trusted or with whom they were in a primary relationship. • with both types of partners while under the influence of substances. Instances of unprotected sex occur in the following three contexts:

  6. Psychosocial Stressors Psychosocial stressors, including isolation, depression, and transphobia, can exacerbate HIV risk and drug using behaviors.

  7. Cross-Sectional Study A cross-sectional study was carried out in San Francisco to learn more about this population and the issues they face.

  8. Study Participants • African-American 110 • Latina 110 • API 112 A total of 332 interviews were conducted with an ethnic minority sample, using a structured questionnaire reflecting the social context and life experiences of the MTF TG community.

  9. TG Community Survey • Participants recruited from community sites, individual referrals, and referrals from collaborating ASOs • 1.5 hr interviews, using structured questionnaire • Half the Latina interviews conducted in Spanish

  10. Transphobia % ever (n)% daily (n) Made fun of/called names for being transgender or effeminate as a child 79% (261) 32% (105) Hit or beaten up for being transgender or effeminate as a child 37% (122) 4% (12) Made fun of/called names for being transgender or effeminate as an adult 39% (131) 8% (26) Hit or beaten up for being transgender or effeminate as an adult 20% (65) 0.3% (1) Told that transgenders were not normal as a child 67% (224) 24% (78)

  11. Transphobia, con’t % ever (n)% daily (n) Told that transgenders were not normal as an adult 63% (208) 9% (31) Felt that being transgender hurts and embarrasses family 58% (194) 0% (0) Had to pretend not to be transgender in order to not hurt family 46% (154) 18% (61) Have lost a job or career opportunity for being transgender 38% (126) 0% (0) Had to move away from family or friends because of being transgender 53% (177) 0% (0) Have been harassed by police for being transgender 61% (203) 5% (18)

  12. Violence and Victimization Ever physically assaulted % (n) Overall 39% (128) African American 39% (44) Asian/Pacific Islander 36% (39) Latina 41% (45) Ever raped as a minor Overall 30% (99) African American 40% (45) Asian/Pacific Islander 12% (13) Latina 37% (41) Ever raped as an adult Overall 25% (82) African American 35% (39) Asian/Pacific Islander 16% (18) Latina 23% (25)

  13. Socioeconomic Hardship Housing situation % (n) Stable housing 47% (157) Unstable housing 44% (147) Homeless 5% (16) Monthly income Less than $500 19% (64) $500 to $1,000 33% (110) $1,000 to $2,000 21% (71) More than $2,000 25% (84) Employment income, past 6 months Full time 28% (92) Part time or temp job 18% (60) No employment income 54% (180)

  14. Mental Health Outcomes Depression (CES-D > 15) % (n) Overall 40% (133) African Americans 37% (41) Asian/Pacific Islanders 24% (26) Latinas 60% (66) Ever considered suicide Overall 45% (149) African Americans 61% (68) Asian/Pacific Islanders 28% (31) Latinas 46% (50) Ever attempted suicide Overall29% (95) African Americans 41% (46) Asians/Pacific Islanders 15% (16) Latinas 45% (49)

  15. Injection Drug Use IDU history % (n) Overall 24% (78) African American 37% (41) Asian/Pacific Islander 12% (13) Latina 22% (24) IDU, past month Overall 7% (24) African American 10% (11) Asian/Pacific Islander 4% (4) Latina 8% (9)

  16. Unprotected Anal Intercourse, past month W/ primary private partner Adjusted % (n / subsample) Overall 36% (62 / 173) African American 36% (24 / 67) Asian/Pacific Islander 34% (19 / 56) Latina 38% (19 / 50) W/ casual partners, past month Overall 18% (22 / 119) African American 31% (11 / 35) Asian/Pacific Islander 11% (4 / 35) Latina 14% (7 / 49) W/ commercial sex partner, past month Overall9% (12 / 131) African American 16% (7 / 44) Asian/Pacific Islander 3% (1 / 29) Latina 7% (4 / 58)

  17. Sex while under the influence, past month With private partner Adjusted % (n / subsample) Overall 72% (117 / 173) African American 76% (51 / 67) Asian/Pacific Islander 54% (30 / 56) Latina 72% (36 / 50) With casual partner Overall 68% (81 / 119) African American 74% (26 / 35) Asian/Pacific Islander 57% (20 / 35) Latina 71% (49 / 25) With commercial sex partner Overall70% (92 / 131) African American 68% (30 / 44) Asian/Pacific Islander 66% (19 / 29) Latina 74% (43 / 58)

  18. HIV and STD Outcomes HIV % (n) Overall26% (86) African American 42% (47) Asian/Pacific Islander 13% (14) Latina 23% (25) Tuberculosis Overall 13% (42) African American 12% (13) Asian/Pacific Islander 3% (3) Latina 24% (26) Hepatitis C Overall 11% (38) African American 22% (25) Asian/Pacific Islander 2% (2) Latina 10% (11)

  19. HIV Testing HIV test, past year % (n) Overall 55% (181) African American 49% (55) Asian/Pacific Islander 46% (51) Latina 68% (75) HIV test, past 6 months Overall 37% (123) African American 38% (43) Asian/Pacific Islander 22% (24) Latina 51% (56)

  20. TB Testing TB test, past year % (n) Overall43% (144) African American 47% (53) Asian/Pacific Islander 32% (35) Latina 51% (56) TB test, past 6 months Overall30% (101) African American 34% (38) Asian/Pacific Islander 20% (22) Latina 37% (41)

  21. Conclusions As a result of pervasive transphobia Transgenders are denied access to social support, housing, employment, healthcare, education and other resources. HIV prevention efforts must focus on reducing social stigma and increasing access to much needed services.

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