Transcript A Community At-risk: Assessing HIV/AIDS in Atlanta’s

Assessing HIV/AIDS in Atlanta’s
Transgender Community
Brian J. Dew, Ph.D., LPC
March 18, 2009
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.
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.
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%
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
Prevalence of Experiencing
Violence (Lifetime)
60
50
40
%
30
20
10
0
Sexual Harassment
Intimidation
Sexual Assault/Rape
Burglary
Unjustified Arrest
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
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%
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%
History of STD Infections
(Lifetime)
40
35
30
25
20
15
10
5
0
HIV/AIDS
Gonorrhea
Genital Warts
HEP C
Syphilis
Herpes (Gen)
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%)
Alcohol and Drug History (Past
90 days)
20
18
16
# of days used last 90
14
12
10
8
6
4
2
0
Alcohol
Marijuana
Meth
Crack Cocaine
Opioids
Poppers
If transgender-related health care information were av ailable to you, would
you be more likely to use them?
Valid
Missing
Total
Yes
No
Total
System
Frequency
92
11
103
22
125
Percent
73.6
8.8
82.4
17.6
100.0
Valid Percent
89.3
10.7
100.0
Cumulative
Percent
89.3
100.0
If transgender-specific HIV/AIDS education and prevention materials were
available to you, would you be more likely to use them?
Valid
Missing
Total
Yes
No
Total
System
Frequency
77
26
103
22
125
Percent
61.6
20.8
82.4
17.6
100.0
Valid Percent
74.8
25.2
100.0
Cumulative
Percent
74.8
100.0
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