Assessing HIV/AIDS in Atlanta’s Transgender Community

1. Assessing HIV/AIDS in Atlanta’s Transgender Community Brian J. Dew, Ph.D., LPC March 18, 2009

2. Why this needs assessment? • Lack of local community based research studies investigating health-risk behaviors in this population. • Atlanta has the largest transgender community in the Southeast • Besides one study on MTF prostitutes, no previous research has been conducted with Atlanta’s transgender community. • Determine the impact of HIV/AIDS in Atlanta’s Transgender Community • Investigate HIV risk factors among Atlanta’s transgender persons.

3. Highlight of findings from Dr. Elifson’s Risk Assessment among Transgender commercial sex workers in Atlanta Atlanta, Georgia Conducted July 1990 – July 1991 53 individuals sampled, 37 of which were HIV+ (70%) Age range: 17 to 43 (mean age was 25) More than 80% were Black Risk Behaviors Identified: Sexual activity possibly related to crack cocaine or other drug use; Unprotected intercourse with infected partners who may have genital ulcer diseases; More likely to engage in receptive anal sex with clients (77%) than with partners (47%); Used condoms more with clients than with steady partners (95%); Use of condoms was not significantly related to HIV status Elfison, K. et al. (1994). Male transvestite prostitutes and HIV risk. American Journal of Public Health, 83(2), 260-262.

4. Sample Demographics (N = 123) Age: 18-62 years (Mean: 34.2 years) Present Gender Identity: 24% FTM 72% MTF 4% intersex Ethnicity: 57.4% African American 27.8% White 7.4 % Multiracial 3.7 % Hispanic Lifetime IV Drug Use (non-hormones or silicone): 18%

5. Sample Demographics Education: 24.8% finished college Work: 27.2% work full time (> 35 hrs/week) Income: 48% earn less than $10,000 Over 25% lost job due to being TG 10% report sex work as primary source of income Homeless: 10% in previous 6 months Relationship status: 23% partnered Health insurance: 42.7% report none 64% report being victim of violence or crime

6. Prevalence of Experiencing Violence (Lifetime) %

7. HIV-related Findings HIV/AIDS Prevalence: 36% 85% of persons: African American All MTF’s Only 40% on any type of medication Reasons for Seroconversion 66.7% cited unprotected sex with a non-transgender male. 2.8% cited sharing of needles 27.8% did not know 84.5% knew someone living with HIV; 71% with AIDS; and 71% knew someone that died from AIDS 42% of HIV+ reported fear of entering ER due to being transgender

8. Sexual At-Risk Behavior Had sex with a person who: Injected drugs (16%) Paid you with money (41.1%) Paid you with drugs (21.3%) Paid you with shelter (19.6%) Ever had unprotected sex with someone you knew was HIV+: Lifetime: 23.8% Past year: 14.2% Past month: 4.7%

9. Sexual At-Risk Behavior Have you ever had unprotected sex knowing that you were HIV+: Lifetime: 48.9% Past Year: 26.6% Past Month: 15.2% Have you ever shared needles to inject hormones, silicone, or drugs without cleaning them? Lifetime: 8.7% Last Year: 4.7% Last Month: 0.9%

10. History of STD Infections (Lifetime)

11. Reasons for HIV Testing Most likely to get tested because it was part of a routine medical exam and/or suggested by health care worker (56%) My partner wanted me to get tested (31.1%) Started feeling sick and could not figure out what was wrong (21.7%) Part of treatment program, jail, or prison (8.6%)

12. Alcohol and Drug History (Past 90 days)

14. Conclusions Transgender population is radically different from MSM population Socioeconomic challenges pose risk to housing, health care, and job training High prevalence rate of HIV (36%) and engagement in high risk sexual activity demonstrate a population at significant risks for HIV and other STD infections. Need for targeted community resources