The Role of Religiosity, Social Support, and Stress-related Growth in Protecting Against HIV Risk among Transgender Women

Abstract

Transgender women completed questionnaires of religiosity, social support, stigma, stress-related growth, and sexual risk behavior. In a multivariate model, both social support and religious stressrelated growth were significant negative predictors of unprotected anal sex, but religious behaviors and beliefs emerged as a significant positive predictor. The interaction between religious behaviors and beliefs and social support was also significant, and post-hoc analyses indicated that high-risk sex was least likely among individuals with high-levels of social support but low levels of religious behaviors and beliefs. These data have important implications for understanding factors that might protect against HIV risk for transgender women. KeywordsTransgender; HIV; sexual risk; religiosity; stress-related growth Transgender women (also referred to as male-to-female or MTF transgender persons) are individuals who are born biologically male, but self-identify as female. Transgender women -especially transgender women of color -constitute a socially marginalized group with multiple stigmatized identities. Social stigma and marginalization are often associated with poor psychological adjustment and increased psychological distress, both critical predictors of high-risk behavior (Bockting, Robinson, & Rosser, 1998). Indeed, transgender women are at increased risk for HIV infection, with estimates of HIV seroprevalence in major urban centers in the United States ranging from 22% to 68 % (Garafalo, Deleon, Osmer, Doll & Harper, 2006;Elifson et al.,1993;Edwards, Fisher & Reynolds, 2007;Clements-Nolle, Marx, Guzman & Katz, 2001;Risser et al., 2005;Xavier, Bobbin, Singer & Budd, 2005). A recent metaanalysis of 29 studies estimated average seroprevalence among transgender women at 28% (Herbst, 2008), and some data suggest that transgender women may have HIV incidence rates higher than any other risk group (Kellogg, Clements-Nolle, Dilley, Katz, & McFarland, 2001). HIV seroprevalence estimates are even higher for transgender women of color; in studies Increased HIV risk among transgender women has been linked to a variety of behavioral factors, including high prevalence of sex work (Operario, Soma & Underhill, 2008;Nemoto, Operario, Keatley, Han & Soma, 2004), increased rates of unprotected anal sex (Garofalo et al., 2005;Nemoto et al., 2004), and high rates of sex under the influence of alcohol or drugs (Bockting et al., 1998; Garofalo et al., 2005). Engagement in these high-risk behaviors has been linked to the stigma experienced by transgender women (Bockting et al., 1998). Some research has specifically linked stressful life circumstances and sexual risk-taking, finding that exposure to stressful events is associated with a variety of unhealthy behaviors, including highrisk sexual behavior and substance use (Johnsen & Harlow, 1996;Lang et al., 2003;Semple et al., 2009). In past studies of transgender women, high rates of discrimination predicted unsafe sex (Bockting, et al., 2002), as did low self-esteem and hist...

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

“…Various aspects of religiosity have been conceptualized and operationalized in different ways, including as individual and collective beliefs, worship practices, and traditions used as coping strategies (Rew and Wong 2006). Religiosity has been found to be related to mental and sexual health outcomes Scott et al 2006;Sinha et al 2007;Turner-Musa and Lipscomb 2007) and is typically theorized to be protective (Cotton and Berry 2007;Cotton et al 2006), as religious beliefs and practices have been identified as important components of resilience to stress (Golub et al 2010). Employing religious beliefs and practices to cope with stressful life events has been shown to be associated with higher self-esteem, better life satisfaction, improved cognitive functioning, and less depressive symptoms (Pargament et al 2004;Park 2006;Yakushko 2005).…”

“…However, religiosity may be a double-edged sword for some LGBT individuals (Golub, et al 2010), particularly black individuals demonstrating non-normative gender and sexuality. While religiosity and affiliation may help counter some oppression related to race, religious institutions likely do not offer parallel benefits related to gender nonconformity and marginalized sexualities (Graham 2012).…”

Resilience in Black Lesbian, Gay, Bisexual, and Transgender Individuals: A Critical Review of the Literature

“…While the physical and psychological health and well-being of Black transgender women have long been studied, it appears that their resilience has only recently been examined (Eyre, Guzman, Donovan, & Boissiere, 2004;Golub, Walker, Longmire-Avital, Bimbi, & Parsons, 2010;Koken, Bimbi, & Parsons, 2009; National Gay and Lesbian Task Force [NGLTF], 2011). Although there is not an abundance of resilience-related literature about transgender individuals, it appears that for some Black transgender men and women, both their connection to members of their racial community and personal traits facilitate the development of resilience.…”

Understanding Transgender Identity Development in Childhood and Adolescence

“…Transgender youth have an elevated rate of emotional problems and disorders associated with trauma, including posttraumatic stress disorder, depression, anxiety, and suicide (Gomez-Gil et al, 2012;Liu & Mustanski, 2012;Roberts et al, 2012;Weinrich, Atkinson, McCutchan, & Grant, 1995). Furthermore, much of the psychological stress associated with transgender identities is thought to be attributable to familial and societal reactions to gender non-conformity rather than to the identity itself (Egan & Perry, 2001;Golub, Walker, Longmire-Avital, Bimbi, & Parsons, 2010;Yunger, Carver, & Perry, 2004). Therefore, encouraging tolerance through education about gender diversity could have profound effects on young people's emotional health (Stieglitz, 2010).…”