Brief Report: Psychosocial Predictors of Engagement in Sexual Risk Behavior Among Trans*female Youth Aged 16–24 Years in San Francisco

Abstract

Background Trans*female youth (TFY) carry a disproportionate burden of HIV. Few longitudinal studies have analyzed both proximal and upstream predictors of changes in HIV-related risk behaviors for TFY. The present analysis aims to identify psychosocial predictors of changes in sexual risk behavior over time for TFY in the San Francisco Bay area. Methods Data come from the SHINE cohort study conducted at the San Francisco Department of Public Health from 2012–2014 (n=263). The relationship between hypothesized psychosocial factors and changes in engagement in condomless receptive anal intercourse over 12-month follow-up was modeled using generalized estimating equations, after adjusting for participant age, race/ethnicity, and education level. Results TFY who were ever in a serious relationship since identifying as trans* (aOR=1.89, 95%CI=1.16–3.08), those who reported recent crack or cocaine use (aOR=2.01, 95%CI=1.05–3.85), and those with a monthly income of over $500 (aOR=0.55, 95%CI=0.35–0.85) had significantly higher odds of condomless receptive anal intercourse over the 12-month study period compared to TFY without these exposures. Those who reported high exposure to gender-based discrimination had significantly increased odds of engagement in condomless receptive anal intercourse compared to those who had low exposure over the study period (aOR=1.70, 95%CI=1.10–2.63). Conclusion Both proximal and structural factors predicted increased engagement in sexual risk behavior among TFY. Results demonstrate the need for a multilevel approach to HIV prevention strategies for this population.

Population-based HIV prevalence, stigma and HIV risk among trans women in Nepal

“…Among trans women, internalized anti-trans stigma affects trans women’s self-esteem and has been associated with depression and trauma [ 13 ], as well as elevated suicidality [ 14 ]. In studies with trans women, internalized anti-trans stigma and discrimination is also associated with mental health issues that result in poor coping strategies, including high risk sex and substance use [ 15 , 16 ]. Stigma that impacts trans women economically results in the need to do sex work, which then increases trans women’s risk of exposure to HIV from having many sexual partners and less power to negotiate condom use due to fear of violence and need for income.…”