abstract: 'Background Transgender women ({''''}trans women{''''}), particularly

  African-American and Latina trans women, have disproportionately high

  prevalence of HIV in the United States (U.S.). In order to decrease

  gender dysphoria and overcome discrimination, trans women affirm their

  gender through social and medical transition, often in contexts of

  economic hardship and sexual risk. This study qualitatively examined how

  gender-affirming behaviors enhance or diminish vulnerability to HIV in

  light of structural and economic barriers to gender transition. Methods

  We conducted individual interviews with 19 adult trans women in two U.S.

  cities (Richmond, VA and St. Louis, MO) who reported one or more sexual

  risk behaviors and recent economic hardship related to

  employment/income, housing, or food security. Interviews were recorded,

  transcribed, and analyzed using thematic content analysis. Results The

  majority (74\%) of trans women were racial/ethnic minorities with mean

  age of 26.3 years. Gender-affirming behaviors varied with 58\% of trans

  women having legally changed their name and gender marker; 79\% having

  initiated hormone therapy; and 11\% having not initiated any medical or

  legal changes. None had undertaken surgical changes. Findings suggested

  that the process of gender transitioning resulted in both increasing and

  decreasing HIV risk. The high need for gender affirmation by male sex

  partners contributed to trans women''s exposure to sexual

  objectification, sexual risk behaviors, and conflicting interests in HIV

  prevention messaging. Loss of housing and employment due to transition

  along with the high costs of transition products and medical visits

  increased reliance on sex work and created new obstacles in accessing

  HIV services. Trans women experienced lower HIV risk as they acquired

  legal and medical transition services, reshaped interactions with sex

  partners, and received gender-affirming support by others, including

  health providers, employers, peers, and housing professionals. Sexual

  abstinence was viewed as a negative consequence of incomplete

  transition, although characterized as a period of low HIV risk.

  Conclusions Structural and policy initiatives that promote safe gender

  transition and economic stability in trans women may play a critical

  role in reducing HIV in this population. Addressing the harmful

  pressures for U.S. trans women to conform to perceived feminine

  stereotypes may also serve an important role.'
affiliation: 'Mayo-Wilson, LJ (Corresponding Author), Indiana Univ, Ctr Sexual Hlth
  Promot, Dept Appl Hlth Sci, Sch Publ Hlth, 1025 E 7th St, Bloomington, IN 47405
  USA.

  Mayo-Wilson, LJ (Corresponding Author), Johns Hopkins Bloomberg Sch Publ Hlth, Dept
  Int Hlth, Social \& Behav Intervent Program, 615 N Wolfe St,Room E5038, Baltimore,
  MD 21205 USA.

  Mayo-Wilson, Larissa Jennings; Wagner, Sarah; Timbo, Fatmata, Indiana Univ, Ctr
  Sexual Hlth Promot, Dept Appl Hlth Sci, Sch Publ Hlth, 1025 E 7th St, Bloomington,
  IN 47405 USA.

  Mayo-Wilson, Larissa Jennings, Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth,
  Social \& Behav Intervent Program, 615 N Wolfe St,Room E5038, Baltimore, MD 21205
  USA.

  Benotsch, Eric G.; Sawyer, Ashlee N.; Smout, Shelby A., Virginia Commonwealth Univ,
  Dept Psychol, 806 West Franklin St, Richmond, VA 23284 USA.

  Grigsby, Sheila; Cathers, Lauretta, Univ Missouri, Coll Nursing, 221 NAB South Campus,Univ
  Blvd, St Louis, MO 63121 USA.

  Poteat, Tonia, Univ N Carolina, Dept Social Med, CB 7240, Chapel Hill, NC 27516
  USA.

  Zimmerman, Rick S., Louisiana State Univ Hlth New Orleans, Sch Nursing, 1900 Gravier
  St,Room 5B14, New Orleans, LA 70112 USA.'
article-number: '782'
author: Mayo-Wilson, Larissa Jennings and Benotsch, Eric G. and Grigsby, Sheila and
  Wagner, Sarah and Timbo, Fatmata and Poteat, Tonia and Cathers, Lauretta and Sawyer,
  Ashlee N. and Smout, Shelby A. and Zimmerman, Rick S.
author-email: ljmayowi@iu.edu
author_list:
- family: Mayo-Wilson
  given: Larissa Jennings
- family: Benotsch
  given: Eric G.
- family: Grigsby
  given: Sheila
- family: Wagner
  given: Sarah
- family: Timbo
  given: Fatmata
- family: Poteat
  given: Tonia
- family: Cathers
  given: Lauretta
- family: Sawyer
  given: Ashlee N.
- family: Smout
  given: Shelby A.
- family: Zimmerman
  given: Rick S.
da: '2023-09-28'
doi: 10.1186/s12889-020-08902-3
eissn: 1471-2458
files: []
journal: BMC PUBLIC HEALTH
keywords: 'Transgender women; Housing; Employment; Economic; Qualitative; U; s;

  HIV; Minority'
keywords-plus: RISK BEHAVIORS; SEX WORK; MEN; FRAMEWORK; HIV/STI; HEALTH; DRUGS
language: English
month: MAY 26
number: '1'
number-of-cited-references: '41'
papis_id: 36fb7e58a393d4015d74b10963106225
ref: Mayowilson2020combinedeffects
researcherid-numbers: 'Smout, Shelby/AHD-7847-2022

  Sawyer, Ashlee/AAI-3584-2021'
times-cited: '18'
title: 'Combined effects of gender affirmation and economic hardship on vulnerability
  to HIV: a qualitative analysis among US adult transgender women'
type: article
unique-id: WOS:000537860400006
usage-count-last-180-days: '0'
usage-count-since-2013: '8'
volume: '20'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2020'