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Assessing HIV/AIDS in Atlanta’s Transgender Community. Brian J. Dew, Ph.D., LPC March 18, 2009. Why this needs assessment?. Lack of local community based research studies investigating health-risk behaviors in this population. Atlanta has the largest transgender community in the Southeast

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Assessing hiv aids in atlanta s transgender community

Assessing HIV/AIDS in Atlanta’s Transgender Community

Brian J. Dew, Ph.D., LPC

March 18, 2009

Why this needs assessment
Why this needs assessment?

  • Lack of local community based research studies investigating health-risk behaviors in this population.

  • Atlanta has the largest transgender community in the Southeast

  • Besides one study on MTF prostitutes, no previous research has been conducted with Atlanta’s transgender community.

    • Determine the impact of HIV/AIDS in Atlanta’s Transgender Community

    • Investigate HIV risk factors among Atlanta’s transgender persons.

Highlight of findings from Dr. Elifson’s Risk Assessment among Transgender commercial sex workers in Atlanta

Atlanta, Georgia

Conducted July 1990 – July 1991

53 individuals sampled,

37 of which were HIV+ (70%)

Age range: 17 to 43 (mean age was 25)

More than 80% were Black

Risk Behaviors Identified:

Sexual activity possibly related to crack cocaine or other drug use;

Unprotected intercourse with infected partners who may have genital ulcer diseases;

More likely to engage in receptive anal sex with clients (77%) than with partners (47%);

Used condoms more with clients than with steady partners (95%);

Use of condoms was not significantly related to HIV status

Elfison, K. et al. (1994). Male transvestite prostitutes and HIV risk. American

Journal of Public Health, 83(2), 260-262.

Sample demographics n 123
Sample Demographics (N = 123)

Age: 18-62 years (Mean: 34.2 years)

Present Gender Identity:

24% FTM

72% MTF

4% intersex


57.4% African American

27.8% White

7.4 % Multiracial

3.7 % Hispanic

Lifetime IV Drug Use (non-hormones or silicone): 18%

Sample demographics
Sample Demographics

Education: 24.8% finished college

Work: 27.2% work full time (> 35 hrs/week)

Income: 48% earn less than $10,000

Over 25% lost job due to being TG

10% report sex work as primary source of income

Homeless: 10% in previous 6 months

Relationship status: 23% partnered

Health insurance: 42.7% report none

64% report being victim of violence or crime

Hiv related findings
HIV-related Findings

HIV/AIDS Prevalence: 36%

85% of persons: African American

All MTF’s

Only 40% on any type of medication

Reasons for Seroconversion

66.7% cited unprotected sex with a non-transgender male.

2.8% cited sharing of needles

27.8% did not know

84.5% knew someone living with HIV; 71% with AIDS; and 71% knew someone that died from AIDS

42% of HIV+ reported fear of entering ER due to being transgender

Sexual at risk behavior
Sexual At-Risk Behavior

Had sex with a person who:

Injected drugs (16%)

Paid you with money (41.1%)

Paid you with drugs (21.3%)

Paid you with shelter (19.6%)

Ever had unprotected sex with someone you knew was HIV+:

Lifetime: 23.8%

Past year: 14.2%

Past month: 4.7%

Sexual at risk behavior1
Sexual At-Risk Behavior

Have you ever had unprotected sex knowing that you were HIV+:

Lifetime: 48.9%

Past Year: 26.6%

Past Month: 15.2%

Have you ever shared needles to inject hormones, silicone, or drugs without cleaning them?

Lifetime: 8.7%

Last Year: 4.7%

Last Month: 0.9%

Reasons for hiv testing
Reasons for HIV Testing

Most likely to get tested because it was part of a routine medical exam and/or suggested by health care worker (56%)

My partner wanted me to get tested (31.1%)

Started feeling sick and could not figure out what was wrong (21.7%)

Part of treatment program, jail, or prison (8.6%)


Transgender population is radically different from MSM population

Socioeconomic challenges pose risk to housing, health care, and job training

High prevalence rate of HIV (36%) and engagement in high risk sexual activity demonstrate a population at significant risks for HIV and other STD infections.

Need for targeted community resources