TRANS-FEMALE YOUTH, DEVELOPMENT, AND HIV RISKErin C. Wilson, DrPH- San Francisco Department of Public Health, erin.wilson@sfdph.org

What we know

Trans-female youth are at high risk for HIV Sample HIV prevalence rates of 19% and

22% (Wilson, 2009; Garofalo, 2006) In San Francisco, there is a rise in AIDS

diagnoses among transfemales under 30

Contextual factors for HIV risk

• Mental health• Social isolation• Economic

marginalization• Incarceration• Health care needs• Misperceptions of risk• Abuse

Gender identity development and correlates?

Adults factors shared by youth

Unique to youth

Gender identity formation among children

Gender identity is typically developed in three stages:

Construction (ages 0–5 years) Consolidation (ages 5–7 years) Integration (ages 7 years and up)

Transgender identity adds additional burden

Dissonance

Exploration

Disclosures

*Identity resolutio

n

* Seth Pardo, Cornell

What all youth need to thrive Physical and

psychological safety Appropriate

structures Supportive

relationships Connectedness,

caring, support and responsiveness

Opportunities to belong and for meaningful inclusion

Positive social norms Support for efficacy

and mattering that includes enabling, responsibility and meaningful challenges

Opportunities for skill building

Integration of family, school and community efforts

Eccles et. al., 2002

Longitudinal study of trans-female youth in the San Francisco, CA Bay Area

Phase I. 8 focus group discussions conducted with

trans-female youth ages 16-24 to investigate of protective factors that promote resilience

*Study funded by the National Institute of Mental Health

Challenges trans-female youth face in gender identity development

Self acceptance and ability to come out

Models for *authentic transitioning and reliable sources of information on gender

Difficulty finding sexual partners

Trauma from gender-related violence and harassment

Accessible medical services to support gender identity development

Lack of familial support Lack of reliable

information and institutional support in schools

Individual Structural

HIV risks may be related to development and intersecting risks

Race/Ethnicity

Youth

HIV

Sexual Behavior

Youth accounte

d for 39% of all new

infections in 2009

Data from 2009 show that

African Americans

accounted for 50% of all HIV

infectionsMSM

account for 49% of the

US population living with

HIV

Negative developmental experiences related to intersections & trans identity put transyouth at risk for….

Low self esteem Negative self-image Physical Violence (a precursor or

outcome) Mental health issues- notably

depression, but some evidence of PTSD Suicide ??

Poor outcomes identified in TRYP data

Individuals Factors Structural Factors

Substance Use (90%) used)

Job discrimination (49%)

Homelessness (43%) Dropped out of school due to gender discrimination (24%)

Victimization by partner (35%)

Incarceration (52% have ever been incarcerated)

Institutionalization (26%)

HIV positive Youth

HIV+ 19%

HIV- 81%%

Results of last HIV test (n=151)

The seroprevalence rate among those who ever engaged in sex work was 23.2% compared to 5.9% among those who never engaged in sex work (p=0.0375)

Yes67%

No33%

*p-value 0.027

Sex Work – Youth

Sex work- TRYP study 2007

What are factors that differentiate youth with a history of sex work?

Higher likelihood of having HIV (23% vs. 6%). Lower educational attainment More homelessness More likely to have been incarcerated More likely to have been abused by a partner Have less overall social support More likely to be victimized in the community More likely to have experienced discrimination

in school environments More likely to have been committed to

inpatient facilities

Protective Factors that promote healthy development – SHINE study

Support Connectedness

to parents Friends are hard

to come by but critical

Jobs Opportunity for

responsibility Skill building

Access to gender-related care Hormones and laser

treatment are key for those starting to transition

breast augmentation critical for older youth

Independence/Distance from trans community

*YouTube and other places in the blogosphere Stories of transitioning and

other information Decreased isolation

Jr. college and university environment

Typical of all young people Unique to trans youth

Gender-related needs must also be met in HIV prevention for trans-female youth

Healthy gender identity develop

ment

Mitigation of

structural risks

Supports- parents, schools, peers,

medical care

HIV preventi

on

Existing Interventions/Programs

Tranny Rockstar Project abstract

State of Prevention Science in HIV

Knowing one’s HIV status PrEP Treatment and Viral load suppression

What we need to know

Youth development model for transgender youth Interventions possible within a paradigm of

treatment as prevention? What supports are necessary and essential to

promoting healthy development among transyouth Chicken or Egg?

Determine which precursors put youth at most risk Determine most critical supports that can mitigate

the effect of deleterious precursors Identify resilience and build upon it in the

development of interventions