Syndemic Theory and HIV-Related Risk Among Young Transgender Women: The Role of Multiple, Co-Occurring Health Problems and Social Marginalization

Abstract

Objectives. We assessed whether multiple psychosocial factors are additive in their relationship to sexual risk behavior and self-reported HIV status (i.e., can be characterized as a syndemic) among young transgender women and the relationship of indicators of social marginalization to psychosocial factors. Methods. Participants (n = 151) were aged 15 to 24 years and lived in Chicago or Los Angeles. We collected data on psychosocial factors (low self-esteem, polysubstance use, victimization related to transgender identity, and intimate partner violence) and social marginalization indicators (history of commercial sex work, homelessness, and incarceration) through an interviewer-administered survey. Results. Syndemic factors were positively and additively related to sexual risk behavior and self-reported HIV infection. In addition, our syndemic index was significantly related to 2 indicators of social marginalization: a history of sex work and previous incarceration. Conclusions. These findings provide evidence for a syndemic of co-occurring psychosocial and health problems in young transgender women, taking place in a context of social marginalization.

Navigating Community Institutions: Black Transgender Women’s Experiences in Schools, the Criminal Justice System, and Churches

“…For example, previous studies have found that high rates of discrimination and victimization predicted unsafe sexual practices among transgender women (Brennan et al 2012;Garofalo et al 2007). Singer and colleagues (2006) describe many of the structural features of VDH, and argue that multiple inequalities contribute to the syndemic of "substance abuse, violence, and AIDS" (SAVA) among socially marginalized groups.…”

Stigmatization and Mental Health in a Diverse Sample of Transgender Women

“…13 Several factors may place transgender women at a higher risk of psychological distress than transgender men, such as greater difficulty blending into society (also known as ''passing'') and experiencing higher levels of genderbased stigmatization and forms of discrimination. 13 These include gender abuse, such as verbal assaults or physical abuse, 11,22 intimate partner violence, 45 and physical or sexual assaults (38%-50%) that might be frequently targeted toward transgender women. 10,11,22 Other factors include a high prevalence sex work as a main economic activity (64%-67%) in samples of transgender women, 45,46 and a high prevalence of sexual risk behaviors among this population.…”

“…13 These include gender abuse, such as verbal assaults or physical abuse, 11,22 intimate partner violence, 45 and physical or sexual assaults (38%-50%) that might be frequently targeted toward transgender women. 10,11,22 Other factors include a high prevalence sex work as a main economic activity (64%-67%) in samples of transgender women, 45,46 and a high prevalence of sexual risk behaviors among this population. Past studies also found that transgender women are more likely to report unstable housing and low income than transgender men.…”

“…Past studies also found that transgender women are more likely to report unstable housing and low income than transgender men. 45,47 The reaction to gender non-conformity is generally thought to be less severe for masculine females as compared to feminine males, regardless of orientation and identity. 48 The combination of these issues implies a unique set of health needs and risks among this specific population.…”

Short Communication: Feasibility and Acceptability of Developing a Multisite Clinical Cohort of Transgender People with HIV Infection

“…2 This population experiences high levels of stigma, violence, depression, sex work, and substance use that make them particularly vulnerable to HIV infection. 3 Recent evidence from cross-sectional and qualitative studies suggests disparities in engagement and retention in care among transgender women compared to other people living with HIV. 4 However, data on clinical outcomes among the HIV-infected transgender women are very limited.…”