A Rapid Needs Assessment

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A Rapid Needs Assessment

• Transgender Male Risks for HIV in San Francisco
• 2008

2
Research Team

• Hale Thompson Principal Investigator
• Sean Saifa M Wall Recruitment Manager
• Chris Roebuck, MPH Methods Consultant

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Community-Based Participatory Research

• Establishing trust between researcher and
  researched asking right questions
• Building capacity of and engaging marginalized
  populations
• Community empowerment
• Improved health outcomes

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COMMUNITY ADVISORY COMMITTEES
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ASSESSMENT DESIGN

• Qualitative
• Multi-Method
• 47 Surveys (n47) 30
• 3 Focus Groups (n17) 50
• 10 Key Informant Interviews (n10) 50
• Community-Driven
• Anonymous

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Realms of Inquiry

• Sexual Behaviors and HIV Knowledge
• Access to Culturally Competent Care
• Depression and Self-Esteem
• Drug and Alcohol Use
• Demographic Info
• Employment, Education and Housing
• Community and Social Support

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DEMOGRAPHIC INFO, N47

• Age Range 18-50
• Mean 30
• Years living as Male 1-16 years
• Mean 7
• Live and Work Stealth 55
• Currently taking Testosterone 79
• Have ever taken T 85
• Have had top surgery 49

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DEMOGRAPHIC INFO, N47

• ID as Gay 28
• ID as Queer 72
• ID as BI 13
• ID as Straight 11
• Single and Cruising 45
• In Open Relationship 13
• Intersex 4
• HIV TMSM 3

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DEMOGRAPHIC INFO, N47

• POC/Mixed 49
• White/Caucasian 51
• Born in U.S 85
• Born in CA 32
• Born in BA 13
• Born in SF 3
• Undocumented to work in U.S 4
• History of incarceration 17

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Testosterone, Stigma, and Four Areas of HIV Risks

• 1 Sexual Networks
• 2 HIV Knowledge Sexual Risk Behaviors
• 3 Psychosocial
• 4 Structural

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SEXUAL NETWORKS

• Finding 1 FTMs may be invisible amongst MSM
  sexual networks and provider settings 55 of the
  sample live stealth and are not out as
  transgender in their work or daily lives.
• Finding 2 Ten years ago 66 of FTMs surveyed
  were either abstinent or monogamous.
  (Clements-Nolle et al 2001). Currently, 64
  report having sex with men in last 12 months.

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HIV Knowledge Sexual Risk Behaviors

• Finding 3 The survey sample demonstrated general
  HIV prevention knowledge and a low perception of
  risk.
• Finding 4 Although engaging in unprotected,
  receptive anal sex (11), the samples greatest
  risks for HIV appear to be around having
  unprotected, receptive frontal sex (34) with
  multiple, high-risk partners.

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HIV Knowledge Sexual Risk Behaviors Contd

• Finding 5 The most popular mode of cruising for
  sex occurs online (66) although 38 reported
  engaging in sex without a barrier with partners
  met online, participants said that online
  cruising is a safe way to disclose transgender
  status and negotiate for safer sex before the
  encounter.

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Psychosocial

• Finding 6 A desire for acceptance, fears of
  rejection, and a negative body image while living
  amongst a body-centric gay culture, are
  perceptions that may propel trans men to engage
  in unsafe sexual behaviors.
• Finding 7 Social isolation is prevalent.
• Finding 8 Transmen reported improved self-esteem
  since transition but may be experiencing high
  levels of depression.
• Finding 9 The sample respondents also reported
  using alcohol (70) and marijuana (51) and other
  drugs at high frequencies compared to the general
  population.
• Finding 10 The sample reported high rates of
  sexual (62) and physical (68) abuse histories.

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Structural

• Finding 11 Local FTMs have healthcare coverage
  (68) at levels somewhat comparable to the
  general population and close to one third report
  not having seen a primary care doctor in the last
  year and may be accessing hormones, syringes and
  needles without appropriate medical supervision.
• Finding 12 Providers and FTM participants
  reported having communication gaps around sexual
  health, testing and treatment those gaps
  perpetuate invisibility and improper data
  collection, and can lead to a visit perceived as
  unsafe, and can deter FTMs from future testing
  and care. 36 percent of survey sample had not
  had an HIV test in the last six months.
• Finding 13 Overall the sample is well educated,
  economically marginalized, underemployed, and
  have experienced perceived discrimination in
  housing and employment.

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Recommendations Increase Visibility, Reduce
Stigma

• Establish TMSM working group to develop action
  plan for TMSM prevention and early intervention.
• Prioritize implementation of more effective data
  collection tools and treatment protocols at MSM
  provider sites (including lexicon).
• Prioritize further research regarding HIV risks
  among TMSM (HIV testing, testosterone sexual
  risk behaviors, depression, substance use,
  histories of trauma) .

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ACKNOWLEDGMENTS

• INDIVIDUAL
• Kate Amitin, Shannon Amitin, Judith Bradford,
  PhD, Jay Davis, Samuel Lurie, Julia Palm, Jenna
  Rapues, Zak Szymanski

• ORGANIZATIONAL
• DPH HIV Prevention, Dimensions Youth Clinic, FTM
  HIV Prevention Listserve, Lyon-Martin Clinic, St.
  James Infirmary, STOP AIDS, Tom Waddell TG
  Clinic, Trans THRIVE, DPH TG Advisory Group