Abstract
Purpose: Transgender women in the United States face elevated rates of HIV and of substance use. Studies measuring overall or aggregate levels of substance use have linked use to increased HIV transmission risk behavior (TRB). Although intensive longitudinal studies in other populations have found day-level links between substance use and TRB, no study has yet explored such links among transgender women. This study aimed to fill this gap in the literature.Methods: Utilizing survey and 60-day timeline follow-back interview data from a sample of 214 transgender women in New York City, we tested whether day-level heavy drinking, marijuana use, and/or nonprescription stimulant use were associated with odds of engaging in any sex (vs. no sexual activity) or engaging in TRB (vs. sex without TRB), adjusting for overall levels of use.Results: Multilevel models showed that each of the three substance types was associated with greater odds of engaging in sex on a given day—and more strongly so for heavy drinking among those with higher rates of heavy drinking, and for stimulant use among those with lower rates of stimulant use. Only marijuana use was associated with greater odds of TRB on a given day, but only among those with higher rates of use.Conclusion: These findings substantiate day-level links between substance use and engaging in sexual activity among transgender women, and importantly, between marijuana use and greater likelihood of TRB on a day when sexual activity occurs. This highlights the importance of addressing substance use for sexual health among transgender women especially focusing on marijuana use.
Highlights
In efforts to better understand and address health inequities experienced by transgender women—defined as individuals assigned a male sex at birth who currently identify their gender as female—greater knowledge is needed regarding risk factors for adverse health outcomes.[1]
In Model 1, we found that individual-level heavy drinking moderated the association between day-level heavy drinking and odds of engaging in sex (AOR = 1.07, p < 0.001)—the positive association between day-level drinking and sexual engagement was higher among individuals who engaged in heavy drinking more often (Fig. 1)
This study is, to our knowledge, the first to test for daylevel associations between substance use and sexual behavior focusing on transgender women
Summary
In efforts to better understand and address health inequities experienced by transgender women—defined as individuals assigned a male sex at birth who currently identify their gender as female—greater knowledge is needed regarding risk factors for adverse health outcomes.[1] One prominent health inequity facing transgender women in the United States is elevated rates of HIV, with an estimated prevalence rate of 21.6%,2,3 likely rooted in discrimination and oppression, and involving high rates of poverty, unemployment, and lack of social support.[4,5,6,7,8,9]. The need for a greater understanding of risk factors influencing HIV transmission risk behavior (TRB) among transgender women is paramount.
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