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TRANS Research

 

HIV Risk Behaviors Among MTF Transgenders of Color

Project Staff: Tooru Nemoto (Principal Investigator), JoAnne G. Keatley (Project Director), Don Operario (Research Associate), Toho Soma (Research Assistant), Melenie Eleneke (Project Assistant), Christine M. Soriano (Project Assistant), Pedro Arista (Project Assistant), Claudia Adao (Health Educator/Outreach Worker), Anna Fernandez (Health Educator/ Outreach Worker), Breonna McCree (Health Educator/Outreach Worker)

Project Description: Investigates the determinants of drug and hormone use and HIV risk and protective behaviors among male-to-female transgenders of color, including African American, Asian and Pacific Islander (API), and Latina transgenders who have engaged in commercial sex work in San Francisco.

Significance: This study will provide a systematic description of drug and hormone use and HIV risk and protective behaviors of transgenders of color where risk and urgent needs for interventions are evident, but research has thus far been limited.

Preliminary Findings based on Focus Groups

  • Mental health issues were the most recurring themes across all ethnic groups, and these issues influenced risky behaviors such as commercial sex work and drug use.
  • Commercial sex work and drug use usually starts during adolescence or early adulthood, so interventions should particularly target transgender youth.
  • Unprotected sex was more common with primary partners than with clients; however, clients will pay more to not use condoms during sex.
  • Existing drug treatment and harm reduction programs are inadequate for the needs of transgender clients; some programs discriminate against transgender clients.
  • Roughly half of the participants reported having supportive parents and family, and family support was associated with more self-esteem.
  • Many participants found support from older transgender mentors who assisted their gender development process, so a mentorship program could benefit transgender youth.
  • Clinics distribute hormone pills but not shots; however, transgenders prefer hormone shots because they find the physical effects more satisfying.
  • Because existing transgender resources are inadequate, transgenders need to help themselves by helping each other. The transgender community, in collaboration with CBOs, need to consistently demand for better resources and funding for transgender programs.

Preliminary Findings based on Survey Questionnaire

  • Distressing HIV rates pervaded the MTF transgender community. Overall, 26% of the sample reported being HIV positive, with 42% among African Americans, 23% among Latinas, and 13% among APIs.
  • Other serious health risks impact the transgender community, including high rates of Tuberculosis, Hepatitis C, and various sexually transmitted diseases.
  • Systems of social oppression contribute to health risks, such as racism, transphobia, economic hardship, lack of access to health care, and lack of socioeconomic resources.
  • Health care systems must address high levels of substance abuse throughout the community.
  • Psychological service providers must address unmet mental health needs in the transgender community.

Transgender Life Care (TLC) Project

Project Staff: Tooru Nemoto (PI, UCSF-CAPS), Dr. Wayne Clark (PI, SFDPH), JoAnne G. Keatley (Project Director, UCSF-CAPS), Don Operario (Evaluator, UCSF-CAPS)

Project Description: The primary goals of the TLC program are to provide enhanced gender- and culturally-appropriate services for transgenders who seek services at Castro Mission Health Center (CMHC). The proposed TLC project will expand existing mental health services to MTF transgenders with multiple problems. The project will implement case management and support group programs for the targeted groups. The case management program for transgenders will be integrated with existing primary health care, HIV/AIDS services, and substance abuse counseling programs at CMHC. The support group program for transgenders will be offered at CAPS, Health Studies for People of Color. Case management and support group programs aim to identify, alleviate, and reduce the prevalence of mental health problems in the transgender community. The target population consists of MTF transgenders in San Francisco. We will particularly target African Americans, Asian Americans, and Latinas, and individuals with co-occurring problems such as HIV and drug abuse.

Significance: The prevalence of mental health problems and other co-occurring health issues in the Male-to-Female (MTF) transgender community reaches near epidemic levels. Due to a complex network of socioeconomic and cultural forces, the MTF transgender community is highly vulnerable to a host of psychological problems—including depression, bipolar disorder, affective disorders, post-traumatic stress disorders (PTSD), alienation, and suicidality—in addition to multiple health problems—including drug and alcohol abuse, HIV/AIDS, and STDs.

There are currently only 2 publicly funded primary health clinics in San Francisco that have programs targeting transgenders; however, neither currently provides expanded mental health services for this population. Most primary health service providers lack the capacity to understand and treat the complex array of mental health issues facing this community, including the effects of hormones on physical and mental health, gender confirmation procedures, and daily living struggles associated with being MTF transgender, in addition to mental health, substance abuse, and HIV/AIDS problems common in this community.

Interesting Findings: A recent study by Nemoto (2001) of 245 MTF transgenders of color in San Francisco has revealed alarming mental health risks co-occurring with other diagnosable health problems. Roughly one-half (58%) of the sample revealed some level of depression during the prior week. Ethnic differences in depression were obtained: 52% of African Americans, 62% of Latinas, and 22% APIs met criteria for depression (based on CES-D standards; Hann, Winter, & Jacobsen, 1999). Almost half of the MTF transgenders of color (48%) had contemplated suicide, and of those, 66% actually attempted suicide. Specifically, 51% of African Americans, 31% of Latinas, and 18% of APIs in the sample had attempted suicide. Mental health services were an urgent need in this population, as 64% of African Americans, 43% of Latinas, and 36% of APIs expressed the need for psychological counseling.

Drug Abuse Treatment for Male-to-Female Transgenders

Project Staff: Tooru Nemoto (Principal Investigator), JoAnne G. Keatley (Project Director), Don Operario (Research Associate), Toho Soma (Research Assistant), Melenie Eleneke (Project Assistant), Christine M. Soriano (Project Assistant), Pedro Arista (Project Assistant), Claudia Adao (Health Educator/Outreach Worker), Anna Fernandez (Health Educator/ Outreach Worker), Breonna McCree (Health Educator/Outreach Worker)

Project Description: CAPS and Walden House propose a two-pronged program to provide culturally- and gender-appropriate substance abuse intervention and treatment services to this population. One component, the TRANS (Transgender Resource and Neighborhood Space) site, will provide participants the opportunity to attend workshops addressing substance abuse, HIV, commercial sex work, and general life skills. In addition, TRANS will provide an informal drop-in center where MTF transgenders can relax, shower, and socialize. Three full-time MTF transgender Outreach Workers-an African American, an API, and a Latina-will recruit MTF transgenders from minority communities and facilitate their participation in CLSP activities. The second component of our program is the Walden House Transgender Recovery Program (WH-TRP), which will expand current residential treatment programs to address the unique needs of MTF transgender clients. WH-TRP will provide expanded therapy, counseling, curricula, mentorship programs, and life training skills for this population. Walden House will hire MTF transgender staff members, including a psychological therapist and detox counselor, to implement new programs and develop sensitivity training workshops for the organization. We will evaluate both projects to assess the impact of expanded services on program retention and success rates, and on participants' drug use, sexual behavior, HIV-related attitudes, and health and well-being.

The two project teams, Walden House and CAPS, initiate a MTF Transgender Network comprising of local Community Based Organizations and AIDS Service Organizations that work with transgenders. This MTF Transgender Network will meet regularly throughout the project to ensure cultural and gender sensitivity of programs, discuss emerging issues in transgender health, and strategize toward long-term solutions for drug and HIV issues confronting this population. We will disseminate findings from the TRANS and WH-TRP programs to MTF Transgender Network members, to national organizations working with the transgender community, at national HIV and public health conferences, and in scientific journals.

Significance: Our prior research with African American, Asian and Pacific Islander (API), and Latina MTF transgenders in San Francisco has revealed alarming levels of high-risk drug abuse, sexual behavior, and injection hormone abuse. An array of psychological, socioeconomic, and cultural forces exacerbate drug and HIV vulnerability in this population, including depression, stigmatization, racism, poverty, and victimization. Moreover, our findings indicated a deficiency in culturally- and gender-sensitive substance abuse treatment programs for MTF transgenders of color.

Interesting Findings: Utilization of TRANS (Transgender Resource and Neighborhood Space) and TRP (Transgender Recovery Program) by the targeted population is very encouraging. To date, over 80 transgender women have enrolled in TRANS. TRP has increased the retention rates of transgender women in treatment and presently has 22 transgender women in their residential treatment program.