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Trans-Female youth, development, and HIV risk

Trans-Female youth, development, and HIV risk. Erin C. Wilson, DrPH - San Francisco Department of Public Health, erin.wilson@sfdph.org. What we know. Trans-female youth are at high risk for HIV Sample HIV prevalence rates of 19% and 22% (Wilson, 2009; Garofalo, 2006)

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Trans-Female youth, development, and HIV risk

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  1. Trans-Female youth, development, and HIV risk Erin C. Wilson, DrPH- San Francisco Department of Public Health, erin.wilson@sfdph.org

  2. What we know • Trans-female youth are at high risk for HIV • Sample HIV prevalence rates of 19% and 22% (Wilson, 2009; Garofalo, 2006) • In San Francisco, there is a rise in AIDS diagnoses among transfemales under 30

  3. Contextual factors for HIV risk Adults factors shared by youth Unique to youth • Mental health • Social isolation • Economic marginalization • Incarceration • Health care needs • Misperceptions of risk • Abuse • Gender identity development and correlates?

  4. Gender identity formation among children Gender identity is typically developed in three stages: • Construction (ages 0–5 years) • Consolidation (ages 5–7 years) • Integration (ages 7 years and up)

  5. Transgender identity adds additional burden * Seth Pardo, Cornell

  6. What all youth need to thrive • Physical and psychological safety • Appropriate structures • Supportive relationships • Connectedness, caring, support and responsiveness • Opportunities to belong and for meaningful inclusion • Positive social norms • Support for efficacy and mattering that includes enabling, responsibility and meaningful challenges • Opportunities for skill building • Integration of family, school and community efforts Eccles et. al., 2002

  7. Longitudinal study of trans-female youth in the San Francisco, CA Bay Area • Phase I. • 8 focus group discussions conducted with trans-female youth ages 16-24 to investigate of protective factors that promote resilience *Study funded by the National Institute of Mental Health

  8. Challenges trans-female youth face in gender identity development Individual Structural • Self acceptance and ability to come out • Models for *authentic transitioning and reliable sources of information on gender • Difficulty finding sexual partners • Trauma from gender-related violence and harassment • Accessible medical services to support gender identity development • Lack of familial support • Lack of reliable information and institutional support in schools

  9. HIV risks may be related to development and intersecting risks Data from 2009 show that African Americans accounted for 50% of all HIV infections Youth accounted for 39% of all new infections in 2009 MSM account for 49% of the US population living with HIV

  10. Negative developmental experiences related to intersections & trans identity put transyouth at risk for…. • Low self esteem • Negative self-image • Physical Violence (a precursor or outcome) • Mental health issues- notably depression, but some evidence of PTSD • Suicide • ??

  11. Poor outcomes identified in TRYP data

  12. HIV positive Youth • The seroprevalence rate among those who ever engaged in sex work was 23.2% compared to 5.9% among those who never engaged in sex work (p=0.0375)

  13. Sex Work – Youth Sex work- TRYP study 2007 *p-value 0.027

  14. What are factors that differentiate youth with a history of sex work? • Higher likelihood of having HIV (23% vs. 6%). • Lower educational attainment • More homelessness • More likely to have been incarcerated • More likely to have been abused by a partner • Have less overall social support • More likely to be victimized in the community • More likely to have experienced discrimination in school environments • More likely to have been committed to inpatient facilities

  15. Protective Factors that promote healthy development – SHINE study Typical of all young people Unique to trans youth • Support • Connectedness to parents • Friends are hard to come by but critical • Jobs • Opportunity for responsibility • Skill building • Access to gender-related care • Hormones and laser treatment are key for those starting to transition • breast augmentation critical for older youth • Independence/Distance from trans community • *YouTube and other places in the blogosphere • Stories of transitioning and other information • Decreased isolation • Jr. college and university environment

  16. Gender-related needs must also be met in HIV prevention for trans-female youth

  17. Tranny Rockstar Project abstract Existing Interventions/Programs

  18. State of Prevention Science in HIV • Knowing one’s HIV status • PrEP • Treatment and Viral load suppression

  19. What we need to know • Youth development model for transgender youth • Interventions possible within a paradigm of treatment as prevention? • What supports are necessary and essential to promoting healthy development among transyouth • Chicken or Egg? • Determine which precursors put youth at most risk • Determine most critical supports that can mitigate the effect of deleterious precursors • Identify resilience and build upon it in the development of interventions

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