Men who have sex with transgender women: challenges to category-based HIV prevention.
ABSTRACT Although transgender women are acknowledged as a priority population for HIV prevention, there is little knowledge on men who have sex with transgender women (MSTGWs). MSTGWs challenge conventional sexual orientation categories in public health and HIV prevention research, and warrant increased attention from the public health community. This paper used qualitative techniques to analyze how MSTGWs describe their sexual orientation identities, and to explore the correspondence between men's identities and sexual behaviors with transgender women. We conducted in-depth semi-structured individual interviews with 46 MSTGWs in San Francisco. We observed a diversity in the ways participants identified and explained their sexual orientation, and found no consistent patterns between how men described their sexual orientation identity versus their sexual behavior and attraction to transgender women. Findings from this qualitative study question the utility of category-based approaches to HIV prevention with MSTGWs and offer insights into developing HIV interventions for these men.
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ABSTRACT: Abstract To study the influence of gender on HIV risk, a sample of the U.S. transgender population (N = 1,229) was recruited via the Internet. HIV risk and prevalence were lower than reported in prior studies of localized, urban samples, but higher than the overall U.S. population. Findings suggest that gender nonconformity alone does not itself result in markedly higher HIV risk. Sex with nontransgender men emerged as the strongest independent predictor of unsafe sex for both male-to-female (MtF) and female-to-male (FtM) participants. These sexual relationships constitute a process that may either affirm or problematize gender identity and sexual orientation, with different emphases for MtFs and FtMs, respectively.Journal of Homosexuality 07/2014; · 0.78 Impact Factor
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ABSTRACT: Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV. Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions. The model examines HIV prevention approaches in TSW in two settings (Lima, Peru and San Francisco, CA, USA) to identify which interventions would probably achieve the UN goal of 50% reduction in HIV incidence in 10 years. A combination of interventions that achieves small changes in behaviour and low coverage of biomedical interventions was promising in both settings, suggesting that the expansion of prevention services in TSW would be highly effective. However, this expansion needs appropriate sustainable interventions to tackle the upstream drivers of HIV risk and successfully reach this population. Case studies of six countries show context-specific issues that should inform development and implementation of key interventions across heterogeneous settings. We summarise the evidence and knowledge gaps that affect the HIV epidemic in TSW, and propose a research agenda to improve HIV services and policies for this population.The Lancet 07/2014; · 39.21 Impact Factor
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ABSTRACT: The term ‘men who have sex with men’ (MSM) as commonly used by HIV/AIDS researchers and policy makers is said to describe an obvious group of men. Or does it? While MSM disrupts the homosexual/heterosexual dichotomy through focusing on sexual practices rather than sexual identity, it remains entrenched in binary understandings of sex and gender. Influenced by queer and trans theories, a genderqueer methodology is employed to examine what discourses are deployed when MSM are categorized as a seemingly homogenous group. Who are the “men” in MSM and what are the material consequences of MSM discourse in HIV/AIDS work? Guided by feminist poststructural and Foucauldian theories, this study highlights how MSM discourse functions to exclude trans, intersex, and other non-normative sexed and gendered people while considering the potentially deadly effects of this discourse on those outside of MSM categorizations particularly focusing on its use in the Canadian Guidelines on STIs.03/2010, Degree: Master of Social Work, Supervisor: Susan Strega