This study identifies contextual factors that predict risky sexual behavior among 153 transgender women who participated in a structured survey soliciting information on demographics, substance use, HIV status, risk behaviors, and other health and psychosocial factors. Multivariate logistic regression models were used to determine predictors. Inconsistent condom use was associated with stimulant use, unstable housing, and recruitment site. Substance use during sex was associated with unstable housing and stimulant use. Sex work was associated with hormone use, gender confirming surgeries, and younger age. When developing interventions for transgender women, it may be useful to focus on predictors of risk behavior rather than predictors of current HIV status (i.e., race/ethnicity as “risk factor”), because these behaviors are the target of interventions aimed at sexual risk reduction. Implications include potential benefits of context-specific interventions, structural interventions addressing barriers to housing and health care, and culturally specific substance abuse treatment programs for transgender women.
HIV+ prisoners reentering their communities are at increased risk for
poor health outcomes and to transmit HIV. We report on a randomized trial
comparing an ecosystem-based intervention and an individually-focused
intervention for reducing HIV transmission risk and improving medication
adherence. Reincarceration was considered as a secondary variable. Both groups
decreased sexual risk behavior over the 12-month follow-up period. Unexpectedly,
the ecosystem intervention group was less likely to be taking medication or to
be adherent and more likely to have been reincarcerated. Failure to demonstrate
a significant advantage of the ecosystem intervention may have resulted from the
difficulty of engaging family and other ecosystem members in the intervention.
Implications for developing and applying interventions for this population are
discussed.
Most US jails and prisons do not provide condoms to prisoners because of concerns about possible negative consequences. Since 1989, the jail system of San Francisco, California, has provided condoms to male prisoners through 1-on-1 counseling sessions. Given the limitations of this approach, we installed, stocked, and monitored a free condom-dispensing machine in a jail to examine the feasibility of this method of providing condoms to jail prisoners. After the machine was installed, we observed increases in prisoners' awareness of programmatic access to condoms and in their likelihood of having obtained condoms. Particularly large increases in condom uptake were reported among those in high-risk groups. Sexual activity did not increase, custody operations were not impeded, and staff acceptance of condom access for prisoners increased.
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