CONTENTS
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Acrobat PDF) |
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Dedication
Page Range: i - iii
DOI:
10.1300/J485v08n02_a
Andrea Jenkins MS
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Introduction
Page Range: 1 - 3
DOI:
10.1300/J485v08n02_01
Walter Bockting PhD, Eric Avery
MD
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Health
and Social Services for Male-to-Female Transgender Persons of Color
in San Francisco
Page Range: 5 -
19
DOI: 10.1300/J485v08n02_02
Tooru Nemoto PhD, Don Operario
PhD, JoAnne G. Keatley MSW
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This article presents findings from an investigation of
health needs, service utilization, and perceived barriers to
services among male-to-female (MtF) transgenders of color in
San Francisco. Focus groups (n = 48) and survey interviews (n
= 332) were conducted with convenient samples recruited from
the community. Participants reported a range of health and
social services needed during the last year, with
African-Americans and Latinas showing particularly strong
service needs. Rates of utilizing services were high for basic
health care but lower for social services, substance abuse
treatment, psychological counseling, and gender
transition-related medical services. No significant ethnic
group differences in health service utilization were found.
Qualitative findings evinced the call for transgender-specific
programs and advanced provider training on transgender issues
such as hormone use, gender transition, HIV/AIDS care and
prevention, substance abuse, and mental health problems.
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Keywords: Transgender, services utilization,
gender transition, drug use, mental health
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The
Role of Male Sexual Partners in HIV Infection Among Male-to-Female
Transgender Individuals
Page
Range: 21 - 30
DOI: 10.1300/J485v08n02_03
Dara L. Coan MPH, Willow Schrager
MPP, Tracey Packer MPH
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Male-to-female transgendered persons (MtF) in San
Francisco have very high HIV prevalence and incidence. To
explore possible sources for these high rates of HIV
infection, a rapid needs assessment was conducted using two
methods: (1) an interviewer-administered, mostly closed-ended
survey with the male partners of MtF persons, and (2) focus
groups with MtF persons. Five main themes were evident from
the findings: (1) male partners of MtF persons are of all
ages, races, sexual orientations, and socioeconomic
backgrounds; (2) high-risk sex occurs between MtF persons and
their male sexual partners, despite a high level of concern
about HIV among both the male and MtF study participants; (3)
drug use appears to play a role in unsafe sex between MtF and
their male partners; (4) male partners of MtF persons may
represent a possible bridge for HIV transmission among
different populations, given that they reported sex with male
and female partners, as well as transgendered partners; and
(5) men engaging in receptive anal sex with MtF partners
probably occurs more frequently than reported by the male
participants, given the comments of MtF study participants.
The results indicate a need for creative, community-based HIV
prevention strategies that target the male partners of MtF
transgendered persons. |
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Keywords: Transgender, sexual partners,
male-to-female, HIV/AIDS |
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A
Needs Assessment of Transgendered People of Color Living in
Washington, DC
Page Range: 31 -
47
DOI: 10.1300/J485v08n02_04
Jessica M. Xavier MPH, Marilyn
Bobbin MBA, MS, RD, Ben Singer PhD candidate, Earline Budd
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A needs assessment (N = 248) conducted in Washington,
DC revealed that transgendered people of color are at high
risk for HIV/AIDS, substance abuse, suicide and violence/
crime victimization. Overall HIV prevalence was 25%, with 32%
in natal males (MTFs, i.e., male-to-females). Four predictors
for HIV positive status were identified through logistic
regressionmale sex at birth, a history of substance abuse,
sexual assault, and unemployment. Substance abuse was found in
nearly half the sample (48%) but only half of those (51%) had
sought treatment for it. Thirty-eight percent reported
experiencing suicidal ideation, with 63% of those attributing
it to their gender issues. Of those with suicidal ideation,
nearly half (49%, or 16% of the entire sample), went on to
make attempt(s) to kill themselves. Forty three percent had
been victims of violence or crime, including 13% who had been
sexually assaulted. Knowledge of the Standards of Care
of the Harry Benjamin International Gender Dysphoria
Association was quite low (9%) and associated with white race,
any higher education beyond high school, and access to sex
reassignment surgery (SRS). Access to SRS, defined as
obtaining vaginoplasties for natal males and chest surgeries
for natal females, was just 4%. White race (versus all other
races, p < .001) and female at birth (versus male, p <
.01) were significantly associated with access to SRS. Use of
hormones at some point during their lives was reported by 51%
of participants. Thirty-five percent were currently taking
hormones, with 72% acquiring their hormones from friends or on
the street. Among natal males, 25% had injected silicone.
Nineteen percent did not have their own living space, and
employment, housing and job training were the most
commonly-reported immediate needs of the sample. The results
of this needs assessment provide evidence of an urgent need
for increased medical and social services specific to
transgendered people of color living in the District of
Columbia. |
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Keywords: Transgender people of color,
African American, Hispanic, HIV/AIDS, health and social
services |
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The
Health and Social Service Needs of Transgender People in
Philadelphia
Page Range: 49 -
56
DOI: 10.1300/J485v08n02_05
Gretchen P. Kenagy PhD
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Two Philadelphia-based HIV service organizations and a
local university collaborated on a study of health and social
service needs of transgender people. Transgender people were
the primary resource for the development of the needs
assessment survey. In this article, the survey development
process, including two discussion groups and two focus groups,
are described. Findings on barriers to care, violence,
perception of public safety and comfort, suicide and health
and social service needs are presented. Total sample size was
81, with 49 male-to-female and 32 femaleto-male transgender
individuals. Most (68%) were African American. About half of
the respondents had thought about attempting suicide. High
levels of violence were reported, especially among
male-to-females. Health and social service needs included job
training/work, dental care, health care, legal services,
transportation, education and housing. |
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Keywords: Transgender, health access, service
needs |
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Health
and Social Service Needs of Transgender People in Chicago
Page Range: 57 - 66
DOI:
10.1300/J485v08n02_06
Gretchen P. Kenagy PhD, Wendy B.
Bostwick MPH
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A needs assessment of transgender people was conducted
in Chicago in 2001 to assess their HIV risks, health and
social service needs, and barriers to care. One-hundred and
eleven transgender individuals, 78 male-to-females (MTFs) and
33 female-to-males (FTMs), participated in the study. Fourteen
percent of respondents reported being HIV-positive; they were
all maletofemale and the majority was of color. Risk factors
for HIV included unprotected sex and willingness to have
high-risk sex in the future. Respondents experienced high
levels of violence. Two-thirds of respondents had thought of
attempting suicide. Respondents reported a high need for
health and social services, particularly MTFs and people of
color. |
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Keywords: Transgender, health, services,
barriers |
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Sex,
Drugs, Violence, and HIV Status of Male to Female Transgender
Persons in Houston, Texas
Page
Range: 67 - 74
DOI: 10.1300/J485v08n02_07
Jan M.H. Risser PhD, Andrea
Shelton PhD, Sheryl McCurdy PhD, John Atkinson DrPH, Paige Padgett
PhD, Bernardo Useche PhD, Brenda Thomas, Mark Williams PhD
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To inform the Community Planning Group (Houston, Texas)
in setting HIV-prevention priorities, risk behavior surveys
were completed by 67 male-to-female (MtF) transgender persons.
By self-identification, 58% were preoperative and 48% were
self-described heterosexual women. We found this small sample
of male-to-female transgender individuals to have high rates
of HIV infection, and high prevalence of risky behaviors,
intimate partner violence, and suicidal ideation. Twenty-seven
percent were infected with HIV. Barriers were seldom used
during oral sex and used less than half the time for anal sex
with either primary or casual partners. Nearly one third of
the sample reported use of methamphetamines, amyl nitrite or
LSD and 40% reported crack or cocaine use. Intimate partner
violence and forced sex were reported by 50% and 25%,
respectively. Suicidal ideation was reported by 16% in the
last 30 days; lifetime suicidal ideation was 60%. |
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Keywords: Transgender, HIV prevention, HIV
risk, violence, drug use |
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Access
to Health Care for Transgendered Persons: Result of a Needs
Assessment in Boston
Page Range:
75 - 91
DOI: 10.1300/J485v08n02_08
Jodi Sperber MSW, MPH, Stewart
Landers JD, MCP, Susan Lawrence MA
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The transgender community is a population group that
has experienced an increase in visibility, with only a small,
concomitant increase in understanding. This study reports on
four focus groups, in which 34 transgendered individuals
discussed their experiences and interactions with the health
care system. The specific aims of the study were as follows: •
Identify the health needs of transgender and transsexual
(TG/TS) individuals; • Hear the experiences and perceptions of
TG/TS individuals who are using the current health care
system; • Identify any barriers to obtaining services, support
and/or resources; • Assess the extent to which health care
providers and systems are able to offer sensitive, high
quality and user friendly services that meet TG/TS consumers'
needs; and • Identify ways that health care services can be
enhanced to better meet the needs of the target population.
What the study found was a system that was anything but high
quality in meeting the needs of TG/TS individuals. Ignorance,
insensitivity and discrimination appear to be the norm.
Specifically, the focus groups found the following: •
Transgendered and transsexual persons frequently encounter
providers who will not treat them and blatantly say so. There
is a need for education and a change in anti-discrimination
law needed to change this. • The lack of provider training on
transgender issues creates insensitivity to simple issues of
respect for trans people. One example is the unwillingness to
address TG/TS people by the pronoun preferred by the
patient/client. • Many providers lack the knowledge to
adequately treat many of the routine health care needs of
TG/TS individuals when such treatment relates to issues of
hormone use, gynecological care, HIV prevention counseling, or
other concerns related to gender or sexuality. • Providers
frequently refer to trans issues in unrelated health care
situations such as setting a broken bone, filling a cavity or
treating a cold. Greater familiarity with the health care
needs of the trans population would reduce such incidents. •
Mental health and substance abuse treatment providers need
additional training in order to work cooperatively with TG/TS
clients to identify when gender issues are or are not relevant
to specific mental health or substance abuse treatment
episodes. Sometimes gender issues are central to mental health
or substance abuse treatment, sometimes they are peripheral
and sometimes they are unrelated. • Discrimination in health
insurance is the rule, not the exception. There is a need for
education to encourage policy changes on the part of insurers
and public policy changes on the part of legislators and
regulators. |
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Keywords: Transgender, needs assessmnet,
TG/TS, health care |
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Identifying
Training Needs of Health Care Providers Related to Treatment and
Care of Transgendered Patients: A Qualitative Needs Assessment
Conducted in New England
Page
Range: 93 - 112
DOI: 10.1300/J485v08n02_09
Samuel Lurie
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The Transgender Training Project of The New England
AIDS Education and Training Center has been providing training
on transgender-related issues to health-care providers in the
New England region since 1999, having trained nearly 600
providers in that time. The Transgender Training Project
embarked on a study during the 2001-2002 grant year to
interview providers of HIV-related care and advocacy on their
knowledge and experience with working with transgendered
people and to assess training needs to increase their
effectiveness with transgendered clients. The methodology
consisted of face-to-face interviews with 13 providers of HIV
treatment and care who are affiliated with the New England
AIDS Education and Training Center network to discuss clinical
challenges in working with transgendered people. In this
exploratory study, we found that providers had: 1. Desire to
treat transgendered patients respectfully but admitted
discomfort and lack of tools for specific
interviewing/assessments. 2. Experience with a range of
transgendered patients, but lack of information on
distinctions among transgendered experiences. 3. Restrictions
based on time constraints that create an overarching barrier
in building trusting relationships with clients, and trusting
relationships are integral to quality care. 4. Concern and
frustration with lack of information, studies and research. 5.
Concern and frustration with lack of treatment guidelines, (or
ability to access them), referral contacts and ways to
advocate for transgender clients. 6. Belief that training by
transgendered people themselves was an essential teaching
element. These results point to the need for the development
and dissemination of specific training materials and resources
for health care providers serving transgendered people living
with or at risk for HIV. |
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Keywords: Transgender, training needs, health
care, HIV/AIDS |
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Gender
as an Obstacle in HIV/AIDS Prevention Efforts for Male-to-Female
Transgenders
Page Range: 113 -
122
DOI: 10.1300/J485v08n02_10
Sheilla Rodríguez-Mader PhD, José
Toro-Alfonso
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Social discourses regarding gender are responsible for
molding people's cognitions, perceptions, behaviors, and
interactions with others. Approaching and understanding gender
socialization is an important strategy that must be included
in the development of HIV/AIDS prevention interventions
efforts targeting male-to-female (MTF) transgender people.
This paper represents an effort to identify the influence of
gender construction among a group of MTF transgenders in
Puerto Rico. Using combined methodology, authors examined
results from a questionnaire and in-depth interviews with a
convenience sample of MTF transgenders living in the San Juan
metropolitan area. Quantitative analysis demonstrated that
this sample is composed of young, unemployed, and under
educated population. Many participated in the sex industry.
Participants reported need for basic health and social
services and alienation from social networks. Qualitative
analysis confirmed their traditional social construction of
the “feminine.” Their discourse underlines their need to
reinforce their identity by the construction of a female self
which undermine their possibilities for negotiating safer sex,
as happens to most females in Latino societies. Social
vulnerability, institutional exclusion, and gender
construction issues are obstacles for the HIV prevention
efforts among these communities. |
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Keywords: Sex work, prostitution, HIV/AIDS,
Latino, transgender, gender ideology
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Are
Transgender Persons at Higher Risk for HIV than Other Sexual
Minorities?: A Comparison of HIV Prevalence and Risks
Page Range: 123 - 131
DOI:
10.1300/J485v08n02_11
Walter Bockting PhD, Chiung-Yu
Huang PhD, Hua Ding MPH, Beatrice "Bean" Robinson PhD, Simon Rosser
PhD, MPH
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Recent studies have shown that transgender people are
at high risk for HIV. Few studies, however, have directly
compared the HIV risks and sexual health of transgender
persons with that of other sexual minority populations. This
study used baseline data of intervention studies targeting
transgender persons, men who have sex with men, and women who
have sex with women and men to compare their HIV risk behavior
and sexual health. No significant differences were found
between transgender persons and nontransgender men or women in
consistent condom use or attitudes toward condom use.
Transgender persons were less likely to have multiple partners
and more likely to be monogamous than men who have sex with
men; no differences were found between transgender persons and
the women in this respect. When combining data on condom use,
monogamy, and multiple partners, transgender persons did not
differ from either nontransgender group in their overall risk
for HIV. Transgender persons were less likely than the men or
the women to have been tested for HIV. With regard to HIV
prevalence, 17% of the men compared to only one transgender
person and none of the women reported being HIV-positive.
Transgender persons were also less likely than men who have
sex with men to use drugs; no differences were found in the
use of alcohol. However, with regard to mental health,
transgender persons were more likely than the men to have
experienced depression and more likely than men or women to
have considered or attempted suicide. Finally, transgender
persons reported the lowest levels of support from family and
peers. Thus, in our sample, transgender persons appear to be
at lower risk for HIV but at higher risk for mental health
concerns than men who have sex with men. Remarkably few
differences were found between transgender persons and women
who have sex with women and men-a finding which might reflect
the impact of social stigma on sexual health and have
implications for the design of future HIV/STI prevention
efforts. |
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Keywords: HIV risk, sexual health,
transgender, MSM, bisexual women |
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