Sex trade in a male-to-female transgender population: psychosocial correlates of inconsistent condom use.
BACKGROUND
Research suggests that because of economic necessity, many male-to-female (MTF) transgender individuals trade sex for money, drugs, housing, and other things they may need. To date, no studies have quantitatively assessed psychosocial correlates of condom use with this population.


METHODS
We conducted a cross sectional study with 190 MTF transgender individuals involved in sex trade in San Francisco, California. Multivariate logistic regression was used to determine factors independently associated with inconsistent condom use during receptive anal sex with exchange partners.


RESULTS
About one fifth of our participants reported inconsistent condom use during receptive anal sex in the past 6 months. In the multivariate model, low self-esteem [adjusted odds ratio (AOR)=3.09; 95% confidence interval (CI) (1.28, 7.47)], a history of forced sex or rape [AOR=2.91; 95% CI (1.06, 8.01)], and use of crack-cocaine [AOR=2.59; 95% CI (1.09, 6.13)] were independently associated with inconsistent condom use.


CONCLUSIONS
Our findings highlight an urgent need for multilevel risk reduction interventions for MTF transgender individuals involved in sex trade. Such interventions will be most effective if they address the psychosocial context of sexual risk taking by focusing on issues such as low self-esteem, sexual violence, and illicit drug use.
Clements-Nolle
Kristen
K
School of Public Health/274, University of Nevada, Reno, Nevada, NV 89557-0036, USA. clements@unr.edu
Guzman
Robert
R
Harris
Susan G
SG
D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D016578:Crack Cocaine; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012309:Risk-Taking; D012649:Self Concept; D011477:Sex Work / Q000523:psychology / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014189:Transsexualism / Q000453:epidemiology* / Q000523:psychology; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*
D016578:Crack Cocaine