from Gender Identity Disorders
October 4, 2007 - Richard A. Crosby with the College of Public Health at the University of Kentucky and Nicole L. Pitts have published "Caught between Different Worlds: How Transgendered Women May Be 'Forced,' Into Risky Sex," in The Journal of Sex Research (Vol. 44; Issue 1, 2007, Pgs 43+).
The authors point out that the risk of HIV infection is far greater among "transgender women" (males who identity as women) than among gays or heterosexuals.
They interviewed 17 African American "transgendered women" for their study. Among the questions asked was how they described themselves: transgender and straight (a biological male who has adopted the gender-role of a woman and has sex with men); or transgender and gay (a biological male who has sex with men).
Fourteen of these men were taking hormones; none had undergone sex change surgery. Eight were involved in prostitution, called sex work or street work by Crosby and Pitts. In addition, six identified as transgendered straight; 5 as straight females; 2 as bisexual females; 2 as transgendered gay; 1 as transgendered bisexual, and 1 as "other."
The researchers say several themes emerged from their interviews with these 17 males who identify as females: 1: Looking for Love. They said they had a strong desire to be loved by a man and were often unwilling to use a condom during anal sex.
2. Hormones are Vital: All but three of the men were taking hormones. They frequently shared needles and purchased hormones off the street.
3. Street Sex Is Common. The men interviewed said that prostitution is part of being a transgendered person. Drug use is also part of this life.
4. Discrimination and HIV Risk. The authors write: "Another common theme extracted from women's narratives is that their HIV risk is tied to societal discrimination and transphobia. Some of those interviewed blamed society for giving them low self-esteem and keeping them from homeless shelters. One claimed that HIV materials are not directed to transgendered women.
The authors conclude that these transgendered women (males who take female hormones and wear women's clothing) have been forced by society to take low-paying jobs. As a result, they struggle to purchase hormones and frequently turn to prostitution to earn a living.
In addition, because these transgendered women take on the role of the woman during sex with males, they are at greater risk for HIV infection because of anal intercourse and the ripping of the lining of the anus.
The researchers also claim that because these men have taken on a female role, they also have little bargaining power in whether or not to use condoms during anal sex.
Transgendered women also face great HIV risks due to using unclean needles and syringes for their hormone injections. "Because hormones are not a drug, it is conceivable that transgendered women are unlikely to perceive themselves as injection drug users (IDUs), thereby making them potentially oblivious to prevention messages and programs promoting the use of clean needles/syringes among IDUs."
Crosby and Pitts also assert that the disconnect between transgendered individuals and the gay community is a risk factor for HIV infection. "The absence of social and emotional support networks may be pushing women into risky sexual relationships in their attempts to find love and acceptance."
They note: "In essence, the psychosocial dynamics that underpin HIV risk behavior of transgendered women are probably consequences of social stigma, high need for affection, acceptance/validation as a woman, the need to earn an income, isolation of mainstream society including gay and lesbian groups, and an intense need to obtain hormones."
The authors claim that interventions aimed only at the individual level are not likely to be effective without bringing about structural changes in communities and the alteration of public policies to accommodate these individuals.