Overlooked, misunderstood and at-risk: exploring the lives and HIV risk of ethnic minority male-to-female transgender youth.
OBJECTIVE
To describe the real life challenges and HIV-risk behaviors of male-to-female (MTF) transgender youth from communities of color.


METHODS
A convenience sample (n = 51) of ethnic-minority MTF transgender youth aged 16-25 years completed an anonymous questionnaire including demographics, psychosocial measures, and participation in substance use and sexual risk behaviors. Descriptive analyses and analyses of association were used to interpret the data.


RESULTS
The median age of participants was 22 years, and 57% were African-American. Twenty-two percent reported being human immunodeficiency virus positive (HIV+). Prevalence of life stressors among the sample included history of incarceration (37%), homelessness (18%), sex in exchange for resources (59%), forced sexual activity (52%), difficulty finding a job (63%), and difficulty accessing health care (41%). Within the past year, 98% had sex with men, 49% had unprotected receptive anal intercourse, and 53% had sex under the influence of drugs or alcohol. Substance use within the past year was common, with marijuana (71%) and alcohol (65%) most frequently reported. Twenty-nine percent of participants had used injection liquid silicone in their lifetime. Other injection drug use and needle-sharing behaviors were rare. Compared with other racial/ethnic groups, HIV was found in higher rates among African-American youth (p < .05). HIV status was not associated with any other demographic characteristic, psychosocial measure, sexual or substance use behavior.


CONCLUSIONS
These findings suggest that MTF transgender youth of color have many unmet needs and are at extreme risk of acquiring HIV. Future research is needed to better understand this adolescent subgroup and to develop targeted broad-based interventions that reduce risky behaviors.
General Academic Pediatrics, Childrens Memorial Hospital/Northwestern University, Chicago, Illinois, USA. rgarofalo@childrensmemorial.org
Robert
R
Garofalo
Joanne
J
Deleon
Elizabeth
E
Osmer
Mary
M
Doll
Gary W
GW
Harper
D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000523:psychology / Q000635:transmission*; D006801:Humans; D008297:Male; D008913:Minority Groups; D012309:Risk-Taking; D012649:Self Concept; D012944:Social Support; D013315:Stress, Psychological; D019966:Substance-Related Disorders; D014189:Transsexualism