Examining the Effects of Transphobic Discrimination and Race on HIV Risk Among Transwomen in San Francisco

Abstract

Transwomen, in particular transwomen of color (TWOC), are among the most vulnerable populations at risk for HIV. This secondary analysis is organized using a gender minority stress framework to examine the effects of transphobic discrimination and race on HIV risk factors. We describe the sample of 149 HIV− adult transwomen in San Francisco and use binary logistic regression to examine the relationship between levels of transphobic discrimination and TWOC status on binge drinking and condomless receptive anal intercourse (CRAI), controlling for potential confounders. Those with high levels of transphobic discrimination had 3.59 fold greater odds of engaging in binge drinking compared to those who reported a low level of transphobic discrimination (95% CI, 1.284–10.034; P = 0.015). TWOC had nearly 3 fold greater odds of CRAI compared to white transwomen (95% CI, 1.048–8.464; P = 0.040). We discuss implications for gender minority stress research and future interventions for this population.

Intersectionality Research for Transgender Health Justice: A Theory-Driven Conceptual Framework for Structural Analysis of Transgender Health Inequities

“…Utilizing a gender minority stress framework, Arayasirikul et al examined transphobic discrimination and “race” in relation to two HIV risk factors (binge drinking and CRAI) among HIV-negative trans women ( n =149) in San Francisco. 54 In bivariate analyses, the authors compared white trans women with “transwomen of color”—the latter included Black (22.8% of sample), Latina (33.6%), and “other” (18.1%) trans women. Results showed that white trans women were disproportionately older, college educated, U. S. born, insured, and reported more transphobic discrimination measures (e.g., ever been denied housing or evicted because of gender identity or presentation).…”

“…Arayasirikul et al situate the transphobic discrimination measures within a gender minority stress framework and they mention heteronormativity and heterosexism. 54 However, they state an intention “to examine the effects of race on HIV risk factors” without explaining how they conceptualize “race”; apart from other explanations, this language of race effects is suggestive of biological determinism. 33,34 Likewise, in their regression analysis of syndemics and social marginalization, Brennan et al controlled for race/ethnicity, because race/ethnicity variables had “significant correlations with indicators of social marginalization.” 12 IRTHJ emphasizes that readers of these articles recognize that race is a product of racialization processes 56 and white supremacy.…”

Hepatitis C seroprevalence and engagement in related care and treatment among trans women

“…Data originate from a cross‐sectional survey among trans women conducted in San Francisco from June 2016 to March 2017. The methods are identical to two previous surveys conducted in 2010 and 2013 with the addition of HCV antibody testing in the current wave. In brief, respondent‐driven sampling (RDS) was used to obtain a diverse, community‐based sample of trans women.…”

“…We included HCV antibody testing and questions on access to HCV-specific care among trans women in the most recent wave of a series of cross-sectional surveys to track HIV in this population. 7,8 The objective was to provide baseline data on prevalence of infection and reach of services as the city scales up its programs to eliminate HCV. were enlisted to recruit their peers.…”

Characterizing Health Inequities for the U.S. Transgender Hispanic Population Using the Behavioral Risk Factor Surveillance System

“…Transgender individuals and members of racial/ethnic minority groups belong to marginalized populations that experience severe health inequity in the United States. Members of these groups are subjected to oppression in the form structural racism 1 and transphobia, 2 which coalesce to limit socioeconomic resources and drive poor health outcomes. For transgender individuals, these inequities include mental health disorders, such as anxiety, depression, suicidality, substance use disorder, [3][4][5] and HIV, 5,6 among others.…”