Syndemic Conditions, HIV Transmission Risk Behavior, and Transactional Sex Among Transgender Women

Abstract

This study examined the effect of four syndemic conditions-namely, polydrug use, depression, childhood sexual abuse, and intimate partner violence-on rates of HIV transmission risk behavior (TRB) and separately, transactional sex among transgender women. TRB was defined as the number of condomless penetrative sex events with a casual or main partner of discordant or unknown HIV status. Using data from 212 transgender women in New York City, multivariable analyses revealed that, compared to those with no syndemic conditions, dramatically higher rates of recent HIV TRB events (ARR = 8.84, p < 0.001) and recent transactional sex events (ARR = 8.32, p < 0.001) were reported by participants with all four syndemic conditions. These findings highlight the importance of considering the role of syndemic conditions in HIV risk among transgender women, and the need for comprehensive psychosocial interventions to improve sexual health among this population.

Application of the “syndemics” theory to explain unprotected sex and transactional sex: A crosssectional study in men who have sex with men (MSM), transgender women, and non-MSM in Colombia

“…Having transactional partners was also frequently reported (71%) and, in this case, none of the psychosocial conditions was related to this behavior. Our findings contrast with those of other studies in transgender women from North America, India, and Jamaica 19 , 35 , 40 relating the accumulation of psychosocial adversities to greater HIV risk behaviors.…”

“…In our sample of transgender women, 62% engaged in unprotected sex, a figure consistent with another report in a larger Colombian sample 38 . Childhood sexual abuse, illicit drug use, and alcohol misuse were reported frequently by transgender women, factors that have been related to greater HIV risk behaviors in transgender women elsewhere 19 , 39 . We found only one factor, forced sex, to be related to unprotected sex.…”

“…Therefore, this study uses the “syndemics” framework to investigate the effects of alcohol misuse, poly-drug use, sexual violence experience, and history of childhood sexual abuse on unprotected sex with three different categories of partners, namely, regular, occasional, and transactional. In transgender women, transactional sex is particularly important in HIV risk acquisition and is related to greater exposure to psychosocial problems 17 , 18 and their accumulation 19 . In MSM, the co-occurrence of psychosocial problems on transactional sex has been less explored despite the high risk of HIV among individuals engaged in transactional sex 20 , 21 and the associations found between experiences of childhood abuse and sexual violence with higher odds of reporting transactional sex 22 .…”

Sheroes: Feasibility and Acceptability of a Community-Driven, Group-Level HIV Intervention Program for Transgender Women

“…Transgender women, although resourceful and resilient, are a highly vulnerable and marginalized population in the United States (US) as well as globally, experiencing high rates of stigma, discrimination, and violence (1)(2)(3)(4)(5). Consequently, given the association of negative health outcomes with stigma and discrimination, transgender women experience severe health disparities across a number of outcomes, including HIV (6)(7)(8)(9). Although no national data yet exist in the US, a meta-analysis found that 28% of transgender women tested positive for HIV (7).…”

Understanding the diverse sexual repertoires of men who have sex with men, trans and gender-diverse groups is important for sexually transmitted infection prevention

“…8 However for trans women and gender diverse groups there continues to be disempowerment, with syndemics of drug use, intimate partner violence, mental ill-health and transactional sex driving HIV and other STI acquisition: considerable stigma, discrimination, marginalisation and persecution remain. 9 In MSM and trans women who do not inject drugs, HIV transmission is predominantly transmitted via penetrative penile-anal sex 10,11 Design and delivery of effective interventions for the prevention of HIV have focussed on penetrative penile-anal sexual behaviours. A combination of effective HIV treatment, HIV treatment as prevention, a significant increase in HIV testing, access to HIV pre-exposure prophylaxis and vaccines against STIs as well as interventions improving condom use have significantly reduced the incidence of HIV in some populations of MSM.…”