Sex,Drugs, Violence,and HIV Status Among Male-to-Female Transgender Persons in Houston,Texas

SUMMARY

To inform the Community Planning Group (Houston, Texas) in setting HIV-prevention priorities, risk behavior surveys were completed by 67 male-to-female (MtF) transgender persons. By self-identification, 58% were preoperative and 48% were self-described heterosexual women. We found this small sample of male-to-female transgender individuals to have high rates of HIV infection, and high prevalence of risky behaviors, intimate partner violence, and suicidal ideation. Twenty-seven percent were infected with HIV. Barriers were seldom used during oral sex and used less than half the time for anal sex with either primary or casual partners. Nearly one-third of the sample reported use of methamphetamines, amyl nitrite or LSD and 40% reported crack or cocaine use. Intimate partner violence and forced sex were reported by 50% and 25%, respectively. Suicidal ideation was reported by 16% in the last 30 days; lifetime suicidal ideation was 60%.     

Repeat HIV Testing and HIV Transmission Risk Behaviors Among Sexually Transmitted Infection Clinic Patients

HIV testing and counseling expends considerable HIV prevention resources and offers great opportunities for HIV risk reduction. Individuals who are at risk for HIV and have not been HIV tested are the focus of current targeted testing campaigns and yet persons who are repeatedly tested for HIV often continue engaging in high-risk practices. This study examined HIV testing, risk behaviors, and other medical diagnostic testing practices of men (N = 231) and women (N = 86) attending an inner-city sexually transmitted infections (STI) clinic. Results showed that 75 (23%) participants had not yet been tested for HIV, 45 (14%) had been tested once, and 197 (63%) had been tested two or more times. Patients that had not been tested and those who were repeatedly tested were similar in their risk behaviors; both demonstrated significantly greater risks for HIV than persons tested just once, although repeat testers were more likely to have had a past STI. HIV testing history was minimally associated with other medical testing and health protective practices, such as testicular self-examination, mammography, and having had PAP tests. Results support targeting high-risk untested persons for HIV testing and suggest an urgent need for interventions to reduce risk behaviors among STI clinic patients who repeatedly test for HIV.     

Identifying Training Needs of Health-Care Providers Related to Treatment and Care of Transgendered Patients: A Qualitative Needs Assessment Conducted in New England

SUMMARY

The Transgender Training Project of the New England AIDS Education and Training Center has been providing training on transgender-related issues to health-care providers in the New England region since 1999, having trained nearly 600 providers in that time. The Transgender Training Project embarked on a study during the 2001–2002 grant year to interview providers of HIV-related care and advocacy on their knowledge and experience with working with trans-gendered people and to assess training needs to increase their effectiveness with transgendered clients.

The methodology consisted of face-to-face interviews with 13 providers of HIV treatment and care who are affiliated with the New England AIDS Education and Training Center network to discuss clinical challenges in working with transgendered people.

In this exploratory study, we found that providers had:

1. Desire to treat transgendered patients respectfully but admitted discomfort and lack of tools for specific interviewing/assessments.

2. Experience with a range of transgendered patients, but lack of information on distinctions among transgendered experiences.

3. Restrictions based on time constraints that create an overarching barrier in building trusting relationships with clients, and trusting relationships are integral to quality care.

4. Concern and frustration with lack of information, studies and research.

5. Concern and frustration with lack of treatment guidelines, (or ability to access them), referral contacts and ways to advocate for transgender clients.

6. Belief that training by transgendered people themselves was an essential teaching element.

These results point to the need for the development and dissemination of specific training materials and resources for health-care providers serving transgendered people living with or at risk for HIV.     

A Needs Assessment of Transgendered People of Color Living in Washington,DC

SUMMARY

A needs assessment (N = 248) conducted in Washington, DC, revealed that trans-gendered people of color are at high risk for HIV/AIDS, substance abuse, suicide and violence/crime victimization. Overall HIV prevalence was 25%, with 32% in natal males (MTFs, i.e., male-to-females). Four predictors for HIV positive status were identified through logistic regression-male sex at birth, a history of substance abuse, sexual assault, and unemployment. Substance abuse was found in nearly half the sample (48%) but only half of those (51%) had sought treatment for it. Thirty-eight percent reported experiencing suicidal ideation, with 63% of those attributing it to their gender issues. Of those with suicidal ideation, nearly half (49%, or 16% of the entire sample), went on to make attempt(s) to kill themselves. Forty-three percent had been victims of violence or crime, including 13% who had been sexually assaulted.

Knowledge of the Standards of Care of the Harry Benjamin International Gender Dysphoria Association was quite low (9%) and associated with white race, any higher education beyond high school, and access to sex reassignment surgery (SRS). Access to SRS, defined as obtaining vaginoplasties for natal males and chest surgeries for natal females, was just 4%. White race (versus all other races, p < .001) and female at birth (versus male, p < .01) were significantly associated with access to SRS.

Use of hormones at some point during their lives was reported by 51% of participants. Thirty-five percent were currently taking hormones, with 72% acquiring their hormones from friends or on the street. Among natal males, 25% had injected silicone.

Nineteen percent did not have their own living space, and employment, housing and job training were the most commonly-reported immediate needs of the sample. The results of this needs assessment provide evidence of an urgent need for increased medical and social services specific to transgendered people of color living in the District of Columbia.     

Timing of HIV Interventions on Reductions in Sexual Risk Among Adolescents

Examined the effectiveness of an HIV intervention program among 151 adolescents ages 13 to 24 years who were randomly assigned to (a) seven sessions of 1.5 hr each (10.5 hr); (b) three sessions of 3.5 hr each (10.5 hr); or (c) a no-intervention condition. Using cognitive-behavioral intervention strategies, social skills and HIV-related beliefs, perceptions, and norms were targeted in both the three- and seven-session, small-group intervention conditions. Regression analysis indicated that over 3 months, the number of unprotected risk acts and the number of sexual partners were lower in the seven-session condition compared to the other conditions. Factors mediating risk acts changed in a complex manner: For example, perceived vulnerability increased for those with initially lower vulnerability scores among youths in the seven-session condition compared to others. Self-approval of condom use was also higher for those with initially low scores in the seven-session compared to the three-session condition. Self-efficacy for risk avoidance and condom use was significantly higher in the three-session condition for those with initially low scores compared to other groups. On the role-play measure, those with higher baseline scores in the low-pressure situation improved significantly only in the three-session intervention; in the high-pressure situation, the participants reported significantly higher scores in the seven-session intervention, and those with higher scores improved the most. Results suggest the importance of multisession HIV intervention programs to be delivered with fidelity in community settings.     

Gender as an Obstacle in HIV/AIDS Prevention: Considerations for the Development of HIV/AIDS Prevention Efforts for Male-to-Female Transgenders

SUMMARY

Social discourses regarding gender are responsible for molding people's cognitions, perceptions, behaviors, and interactions with others. Approaching and understanding gender socialization is an important strategy that must be included in the development of HIV/AIDS prevention intervention efforts targeting male-to-female (MTF) transgender people.

This paper represents an effort to identify the influence of gender construction among a group of MTF transgenders in Puerto Rico. Using combined methodology, authors examined results from a questionnaire and in-depth interviews with a convenience sample of MTF transgenders living in the San Juan metropolitan area.

Quantitative analysis demonstrated that this sample is composed of young, unemployed, and undereducated population. Many participated in the sex industry. Participants reported need for basic health and social services and alienation from social networks. Qualitative analysis confirmed their traditional social construction of the “feminine.” Their discourse underlines their need to reinforce their identity by the construction of a female self which undermines their possibilities for negotiating safer sex, as happens to most females in Latino societies.

Social vulnerability, institutional exclusion, and gender construction issues are obstacles for the HIV prevention efforts among these communities.     

Subverting Culture: Promoting HIV/AIDS Prevention Among Puerto Rican and Dominican Women

This article discusses the challenges faced by researchers and interventionists when attempting to promote change in social norms and normative beliefs that promote HIV/AIDS risk-related behaviors among Puerto Rican and Dominican women. The article focuses on the role of culture in HIV/AIDS prevention with women by analyzing the sociohistorical context of some cultural beliefs and by illustrating the tension between risk-related and protective cultural beliefs in research conducted by the authors with women in both New York and Puerto Rico. The authors propose that promoting changes in sex-related social norms and normative beliefs might be constructed as a subversive act and present the challenge this analysis poses for community psychology. They conclude that this conceptualization might be construed as subversive because rather than idealizing culture, it promotes changes that respect diversity within the culture and foster participation in the development of new cultural values, beliefs and norms.     

The Use of Religion Among HIV-Infected African American Women

A study of the associations among physical and mental health and differential patterns of religiosity among African American women was conducted with a sample of 253 participants: 104 HIV-infected, 46 chronically ill (not HIV-infected), and 103 healthy subjects. Participants' uses of private (i.e., prayer) and public (i.e., church attendance) forms of religiosity were assessed using data from semi-structured interviews. The relationship between religiosity and mental health exhibited an incongruous pattern, differing across health condition and forms of religious behavior. The practice of public religiosity was found to be inversely associated with engagement in high-risk health behaviors among HIV-infected and healthy women but not among the chronically ill. Although private religiosity was unrelated to participants' perceptions of physical health, public religiosity was positively associated with physical health among HIV-infected women and inversely associated with their CD4 count. Finally, having a sense of control over one's health was positively related to religiosity. Results from this study support the important role religion plays for persons faced with chronic terminal diseases, as in the case of HIV/AIDS.     

CD4 Count and Physical Symptoms Among Urban African American Mothers with HIV: An Examination of the Role of Optimism and Depressive Symptoms

The current study examined the link between immune functioning (CD4 count) and physical symptoms, as well as the moderating role of optimism and depressive symptoms, in a sample of 99 low income, inner city African American women with HIV. Although there was no main effect of CD4 count on physical symptoms, depressive symptoms moderated the association between CD4 count and physical symptoms. More compromised immune functioning (lower CD4 count) was associated with more physical symptoms under conditions of higher levels of depressive symptoms, but not lower levels of depressive symptoms. This finding was observed using both a self-report measure and a clinician-rating of women’s depressive symptoms. There were no main or interactive effects for optimism. Clinical implications and future research directions are presented.     

Differential Risk Perceptions for Unintended Pregnancy,STDs, and HIV/AIDS Among Urban Adolescents: Some Preliminary Findings

Two pilot studies tested the hypothesis that adolescents perceive differential risks for unintended pregnancy (UP), sexually transmitted diseases (STDs), and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The 1st study used a college sample consisting of 14 adolescents (21 years or younger) and 64 adults (over 21) who rated the likelihood that they and others would experience 15 health problems. The 2nd study used a community sample of 48 adolescents between 16 and 21 years of age who rated 11 health problems in a similar manner. Optimistic bias and uniqueness of risk in adolescents' perceived susceptibility to adverse sexual outcomes were examined. Optimistic bias is the difference between ratings of risk to self and risk to others, reflecting lower risk to self. Uniqueness of risk is the difference between ratings of risk and a baseline risk estimate (i.e., the mean rating for all non-sex-related health problems). Consistent with the hypothesis, adolescents perceived differential risks for UP, STDs, and HIV/AIDS. Implications for adolescent prevention programs are discussed.     

Using the Theory of Gender and Power to Examine Experiences of Partner Violence,Sexual Negotiation,and Risk of HIV/AIDS Among Economically Disadvantaged Women in Southern India

This article uses the Theory of Gender and Power to examine women's vulnerability to HIV/AIDS in order to: understand the vulnerability of female sex workers/poor women due to poverty and lack of educational resources; explore women's vulnerability in the context of client/partner violence, alcohol use, male partner's high-risk behaviors, and women's lack of control in their intimate relationships; and explore the role of traditional heterosexual gender norms in the outcomes of sexual negotiation. Ethnographic data were collected from 32 women and 38 men in India as part of an ongoing National Institute of Mental Health study. Results highlighted women's vulnerability to HIV/AIDS stemming from partner violence, alcohol use, poverty, dangers of sex work environments, and tacit acceptance of cultural/gender norms.     

艾滋病防治中几个问题

HIV感染/艾滋病是一类新发的传染病,呈现全球大流行趋势,我国艾滋病流行经历了3个阶段,目前正处于HIV感染高速发展期,在地域范围、人群特点、传播途径等方面有了新变化,亟需从全社会各个层面上积极协作,有效地遏制疫情的蔓延。     

Routine third party disclosure of HIV results to identifiable sexual partners in Sub-Saharan Africa

The challenges of dealing with disclosure of HIV status cause frustration to health care providers and counselors. This frustration follows from the already known high risk to the third party on one hand and our ethical obligation to “respect persons” in terms of privacy and confidentiality on the other side. Given the stubbornly low rates of voluntary disclosure (partner notification) among couples, however, it is quite tempting to suggest a paradigm of routine third party disclosure to identifiable sexual partners by health care providers. This might be the lesser of the two evils and might give better public health outcomes in the fight against HIV/AIDS in Sub-Saharan Africa.     

盘锦市2005年～2013年艾滋病流行特征分析

分析盘锦市艾滋病瘦情流行特征,为预防控制提供依据.对盘锦市2005年～2013年艾滋病瘦情数及流行病学调查资料进行统计分析.结果盘锦市2005年～2013年累计报告HIV/AIDS 127例,病例逐年上升,男性显著高于女性,发病年龄以20岁～44岁的青壮年,未婚占54.88％,感染途径以性途径为主,占95.28％,男男同性占61.42％,病例主要发现途径为医疗机构的检测及疾控机构的检测咨询.因此,盘锦市的艾滋病瘦情呈上升趋势,以性传播途径为主,尤其是男男同性增加明显.     

盘锦市2005年～2013年艾滋病流行特征分析

分析盘锦市艾滋病瘦情流行特征,为预防控制提供依据.对盘锦市2005年～2013年艾滋病瘦情数及流行病学调查资料进行统计分析.结果盘锦市2005年～2013年累计报告HIV/AIDS 127例,病例逐年上升,男性显著高于女性,发病年龄以20岁～44岁的青壮年,未婚占54.88％,感染途径以性途径为主,占95.28％,男男同性占61.42％,病例主要发现途径为医疗机构的检测及疾控机构的检测咨询.因此,盘锦市的艾滋病瘦情呈上升趋势,以性传播途径为主,尤其是男男同性增加明显.     

A six-month follow-up of adolescents' sexual risk-taking,HIV/AIDS knowledge,and attitudes to condoms

A follow-up study was conducted to investigate change in sexual behaviour, knowledge about HIV/AIDS transmission, and attitudes to condoms over a 6-month period in a sample of late-adolescent students. The study also obtained subjective reports of HIV/AIDS-relevant change. Overall there was a decrease in sexual risk-taking behaviour with casual partners but no change occurred in sexual behaviour with regular partners, knowledge about HIV/AIDS, attitude towards condoms, or intention to use a condom on next sexual encounter. Examination of individual data revealed that, for some adolescents where behavioural change had occurred, this was in the direction of less safe sex. There were few self-reports of change in sexual behaviour, intention to take precautions against HIV/AIDS, or concern about HIV/AIDS over the preceding 6 months. Subjective reports of behaviour change did not correspond with reports of actual behaviour. Low rates of behaviour change are attributed to the failure of adolescents to personalize the threat of AIDS and to their trust in the safety of sex with a regular partner as well as to the lack of relevance of HIV/AIDS education campaigns to this group.     

Risk perception and victim perception: The judgment of HIV cases

There is a vast literature confirming that reactions to different risks are strongly affected by characteristics other than scientific risk estimates; most of this research has concentrated on mapping people's representations of sets of widely varying dangers (e.g. diseases, natural disasters, accidents). This study explored a potentially vital component of risk that cannot be studied by eliciting general reactions to many hazards: the extent to which who is at risk contributes to perceptions and judgments of a risk. While it may be preferable to assume that misfortunes affect the population uniformly, of course the truth is not so egalitarian. Thus, for both theoretical and policy reasons, it is worth exploring psychometrically representations of a particular risk as it affects different people. Using multidimensional scaling and hierarchical cluster analysis, we constructed models of respondents' representations of a disease assumed to be particularly affected by victim perception: Human Immunodeficiency Virus (HIV). Subjects rated the similarity of all possible pairs among 16 scenarios involving HIV infection; the scenarios contained information about both the victim and the method of contraction. A set of attribute scales as well as political/demographic information allowed us both to interpret the structures and to predict individual differences. The results confirmed that reactions to HIV infection are greatly affected by reactions to the victim. In particular, the perceived distastefulness and riskiness of the method of infection loomed larger than did either the overall likability of the victim or the general riskiness of the victim's behavior. Further, the salience of the most statistically influential dimension, ‘deservedness’, depended significantly on demographic and political characteristics of the respondents, suggesting that the relationship between personal values and risk perception is in part mediated by victim perception. Implications for risk perception work and public policy are discussed.     

Couples of Mixed HIV Status

Abstract

As individuals with HIV are living longer due to earlier diagnosis and advances in treatment, they are turning their attention to living with HIV/AIDS. Based on a study (n = 82) that explored how HIV may affect the intimacy of long-term couples of mixed HIV status, psychosocial issues are identified. Key findings include the identification of six themes. They are: (1) fear of HIV transmission, (2) HIV and health status, (3) shifts in emotional intimacy, (4) assumption of care-giver and patient roles, (5) reproductive issues, and (6) a perceived sense of power inequity present between the genders and between HIV positive and HIV negative partners. Implications for the practitioner are discussed.