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

https://doi.org/10.1016/j.jana.2009.06.003Get rights and content

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.

Section snippets

Design and Setting

Between August and November 2008, 11 participants completed a one-on-one, in-depth, semistructured qualitative interview and brief quantitative survey. Study activities took place at Fenway Health (FH), a freestanding health care and research facility specializing in HIV care and serving the needs of the lesbian, gay, bisexual, and transgender community in the greater Boston area (Mayer et al., 2001). The FH institutional review board approved the study protocol.

Sample

Individuals were eligible for

Results

Table 1, Table 2, Table 3 outline the demographic characteristics, sexual and substance use risks, and psychosocial characteristics of the study sample (N = 11). Participants ranged in age from 21 to 52 years and had a mean age of 34.6 years (SD = 10.6). Persons of color represented almost two thirds (63.7%) of the sample. A total of 4 participants (36.4%) were infected with HIV. Other demographic and risk variables will be discussed in the context of qualitative results.

Discussion

Results from this study suggest that transgender women who exchange sex for money, drugs, housing, and other services are a population at high risk for HIV acquisition and transmission. In qualitative interviews, inconsistent condom use with offers of more money for unsafe sex and low rates of HIV status disclosure were commonly reported. A majority of the sample reported unprotected anal sex with transactional male sex partners of unknown or different serostatus in the past 12 months, and all

Acknowledgment

The project described in this article was supported by The Center for Population Research in Lesbian, Gay, Bisexual, and Transgender Health at The Fenway Institute and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under Award Number R21HD051178. Some of the investigator time on this project was also supported by grant number R03DA023393 from the National Institute on Drug Abuse (NIDA) and from the Lifespan/Tufts/Brown University Center for AIDS

Sari L. Reisner, MA, is Epidemiology Projects Manager, The Fenway Institute, Fenway Health, Boston, Massachusetts.

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    Sari L. Reisner, MA, is Epidemiology Projects Manager, The Fenway Institute, Fenway Health, Boston, Massachusetts.

    Matthew J. Mimiaga, ScD, MPH, is Research Scientist, The Fenway Institute, Fenway Health, Boston; and Instructor, Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston.

    Sean Bland, BA, is Research Associate for Epidemiology and Behavioral Science Studies, The Fenway Institute, Fenway Health, Boston.

    Kenneth H. Mayer, MD, is Co-Director, The Fenway Institute, Fenway Health, Boston; Director, Brown University AIDS Program, Providence, Rhode Island; Professor of Medicine and Community Health, Brown University Medical School, Providence; and Professor of Medicine and Community Health, Brown University, Providence.

    Brandon Perkovich is an undergraduate student, Harvard College, Cambridge, Massachusetts.

    Steven A. Safren, PhD, is Senior Research Scientist, The Fenway Institute, Fenway Health, Boston; Director of Behavioral Medicine, Massachusetts General Hospital, Boston; and Associate Professor of Psychology, Department of Psychiatry at Harvard Medical School, Boston.

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