It’s not just About Condoms and Sex: Using Syndemic Theory to Examine Social Risks of HIV Among Transgender Women

Abstract

Transgender women (transwomen) encounter complex, social, psychological, and economic conditions that specifically heighten their risk for HIV (Hankins 2013; Hwahng and Nuttbrock 2007; Centers for Disease Control & Prevention [CDC] 2011). While national HIV data specific to transgender women is lacking, studies conducted in major metropolitan cites suggest staggering prevalence rates exceeding those of all other gender and sexual minorities (Clements-Nolle et al. 2001; Herbst et al. 2008; Kenagy 2002; Nemoto et al. 2004a; Wiessing et al. 1999). Among transwomen, HIV prevalence rates ranging from 11–78 % have been reported (Clements-Nolle et al. 2001; Herbst et al. 2008; Kenagy 2002; Nemoto et al. 2004a; Wiessing et al. 1999). For high-risk groups, such as African American and Hispanic/Latina transwomen and transwomen who engage in commercial sex work, the HIV disparity widens (Nuttbrock et al. 2009). Worldwide, the burden of HIV in transwomen escalates to an astonishing rate, with recent reports showing that transwomen are 49 times more likely than non-transgender persons to be HIV infected (Baral et al. 2012). These shocking rates underscore the urgent need for HIV prevention, treatment, and care that focuses specifically on this population. Given that individual behaviors alone do not account for the disproportionate rates of HIV infection among transwomen (CDC 2011), a syndemic model that is specific to the needs of transwomen and that address (or describes) the individual, social, and structural factors that influence their risk for HIV is warranted.