Housing Status and HIV Risk Behaviors Among Transgender Women in Los Angeles

Fletcher, Jesse B.; Kisler, Kimberly A.; Reback, Cathy J.

doi:10.1007/s10508-014-0368-1

Cited by 83 publications

(74 citation statements)

References 40 publications

(59 reference statements)

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“…Many high-risk trans women experience homelessness (Mottet & Ohle, 2006; Spicer, 2010; Fletcher, Kisler, & Reback, 2014), substance use including addiction (Benotsch et al, 2013; Herbst et al, 2008; Hoffman, 2014; Santos et al, 2014; Wolf & Dewa., 2012), mental health comorbidities (Bockting, Miner, Swinburne Romine, Hamilton, & Coleman, 2013; Fredriksen-Goldsen et al, 2013; Gijs, van der Putten-Bierman, & De Cuypere, 2014; Gleason, Costanzo, Oost, Livingston, & Cochran, 2014; Horvath, Iantaffi, Swinburne-Romine, & Bockting, 2013), and engagement in sex work (Bowers, Branson, Fletcher, & Reback, 2012; Hoffman, 2014; Nadal, Davidoff, & Fujii-Doe, 2013; Operario, Soma, & Underhill, 2008; Reback & Fletcher, 2014), each of which can reduce the time, inclination, and/or ability to enter into HIV services (Rapues, Wilson, Packer, Colfax, & Raymond, 2013). Simply meeting basic needs such as locating food, clothing, and/or shelter may be more pressing than the perceived need for services (Center for Disease Control and Prevention [CDC], 2007).…”

Section: Recruitment and Hiv Testing For High-risk Trans Womenmentioning

confidence: 99%

Recruiting, Linking, and Retaining High-Risk Transgender Women Into HIV Prevention and Care Services: An Overview of Barriers, Strategies, and Lessons Learned

Reback

Ferlito

Kisler

et al. 2015

International Journal of Transgenderism

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Despite disproportionately high HIV prevalence rates and high risk for HIV acquisition and transmission, trans women in the United States are less likely than other high-risk populations to be aware of their HIV status or to perceive HIV infection as a serious health threat. Furthermore, concurrently high rates of unstable housing, few legal employment opportunities, lack of social support, and distrust of social service providers limit trans women's interest or ability to be recruited by, retained within, or linked into HIV prevention and care services. This article provides an overview of the barriers that prevent many high-risk trans women from being recruited, linked, and retained within HIV prevention and care services as well as accessing HIV testing services, and discusses several strategies for overcoming these barriers. Best practices in working with high-risk trans women include hiring trans women indigenous to the local trans communities, designing culturally specific recruitment and retention strategies including the creation of living “community maps” to ensure successful community outreach, the construction of a trans women-specific CAB to create dialogue with community stakeholders including consumers, and extensive cultural sensitivity training for staff and community collaborators to sensitize them to the specific needs of high-risk trans women participants.

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Section: Recruitment and Hiv Testing For High-risk Trans Womenmentioning

confidence: 99%

Recruiting, Linking, and Retaining High-Risk Transgender Women Into HIV Prevention and Care Services: An Overview of Barriers, Strategies, and Lessons Learned

Reback

Ferlito

Kisler

et al. 2015

International Journal of Transgenderism

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“…15,19 The effects of discrimination on mental health contribute to low negotiation power and lack of consistent condom use for TW in commercial as well as personal sexual relationships, increasing their HIV risk. 14,20 Furthermore, finding gender affirmation in a sexual partner is very important for transgender women's mental health. 21 Although studies have included African American and Latina TW in their samples, 2,15,22,23 few have assessed contextual determinants of HIV specific to these groups.…”

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confidence: 99%

Documentation Status as a Contextual Determinant of HIV Risk Among Young Transgender Latinas

et al. 2016

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Purpose: The purpose of this study was to explore the contextual factors that determine or mitigate vulnerability to HIV among Latina transgender women. Documentation status (legal authorization to live in the United States) has been cited by other studies as a barrier to recruitment or engagement in HIV-related care among immigrant Latinos, but not explored as a determinant of HIV risk for transgender immigrant Latinas. Methods: We collaborated with a community-based organization to explore these contextual, including social and structural, factors. In-depth interviews in Spanish captured life histories of eight 18-to 29-year-old transgender Latinas, who collectively self-identify as chicas trans. Codes were assigned deductively from the interview guide, and emerging themes were identified throughout data collection. Results: Most participants migrated to the United States from Central America after experiencing discrimination and violence in their countries of origin. Participants emphasized documentation status as a critical factor in three areas related to social and structural determinants of HIV risk: gender identity expression, access to services, and relationship power dynamics. Chicas trans who gained legal asylum reported greater control over sexual relationships, improved access to services, and less risky employment. Conclusions: Documentation status emerged as a key HIV risk factor for this population. For undocumented transgender Latinas, legal asylum appears to be a promising HIV-related protective factor. Further research could assess whether legal assistance combined with wraparound support services affects HIV prevention for this population.

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“…Specifically, trans women face significantly high rates of victimization and violence, homelessness, substance use, HIV/AIDS, mental health issues and suicide, incarceration, and poverty (Bradford, Reisner, Honnold, & Xavier, 2013; Fletcher, Kisler, & Reback, 2014; MacCarthy, Reisner, Nunn, Perez-Brumer, & Operario, 2015; Reback & Fletcher, 2014; Shelton, 2015; Stotzer, 2009; Yang, Manning, van den Berg, & Operario, 2015). The cyclical and syndemic nature (Brennan et al, 2012) of these health disparities is complex: the disparities often force trans women into street economies such as sex work to survive (Hwahng & Nuttbrock, 2007; James et al, 2016; Wilson et al, 2009), and high-risk sexual activity has been associated with worse health outcomes, including HIV infection and non-prescribed hormone use (Kurtz, Surratt, Kiley, & Inciardi, 2005; Nemoto, Bödeker, & Iwamoto, 2011).…”

Section: Introductionmentioning

confidence: 99%

“…The 2015 USTS found that 23% of respondents had experienced housing discrimination in the past year due to being transgender (James et al, 2016). A study from Los Angeles investigating homelessness and HIV risk among trans women (N = 517) found that less than half of the participants reported being stably housed: 22.4% reported being marginally housed and 34.8% reported being homeless (Fletcher et al, 2014). Homelessness and unstable housing among trans women have both been associated with substance use, mental health issues, HIV risk, and hormone misuse (Fletcher et al, 2014; Spicer, 2010).…”

Section: Introductionmentioning

confidence: 99%

Structural Inequities and Social Networks Impact Hormone Use and Misuse Among Transgender Women in Los Angeles County

et al. 2018

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In order to reduce gender dysphoria and combat stigma, transgender women often affirm their gender through social and medical transition, which may include cross-sex hormone therapy. This study examined associations between medically monitored hormone use and hormone misuse (non-prescribed hormone use including “fillers”), structural inequities (access to housing, health insurance, and income) and social network dynamics among 271 transgender women in Los Angeles. Hormone use status was coded trichotomously (hormone use, hormone misuse, no hormone use), and robust multinomial logistic regression as well as novel social network analysis were conducted to examine associations. Results demonstrated that younger, African American/Black transgender women were most likely to engage in hormone misuse compared to transgender women who were older or non-African American/Black. One-third of the sample reported sex work as a main source of income, and this group was more likely to misuse hormones than those with another primary source of income. Transgender women with access to stable housing and health insurance were most likely to engage in medically monitored hormone use. Social network analysis revealed that transgender women with a greater number of hormone-using network alters were most likely to misuse hormones, but that using the Internet to find transgender friends mitigated this association. Results demonstrate the multi-faceted risk profile of transgender women who use and misuse hormones, including that social networks play an important role in hormone usage among transgender women.

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Housing Status and HIV Risk Behaviors Among Transgender Women in Los Angeles

Cited by 83 publications

References 40 publications

Recruiting, Linking, and Retaining High-Risk Transgender Women Into HIV Prevention and Care Services: An Overview of Barriers, Strategies, and Lessons Learned

Recruiting, Linking, and Retaining High-Risk Transgender Women Into HIV Prevention and Care Services: An Overview of Barriers, Strategies, and Lessons Learned

Documentation Status as a Contextual Determinant of HIV Risk Among Young Transgender Latinas

Structural Inequities and Social Networks Impact Hormone Use and Misuse Among Transgender Women in Los Angeles County

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