STIGMA AND THE SYNDEMIC OF HIV-RELATED HEALTH RISK BEHAVIORS IN A DIVERSE SAMPLE OF TRANSGENDER WOMEN

This study examined HIV-related health risk behaviors-unprotected anal intercourse, alcohol intoxication, and drug use-and their association with stigma in a sample of transgender women. We conducted a cross-sectional survey of 191 transgender women recruited through purposive sampling in San Francisco, CA. Unprotected anal intercourse, alcohol intoxication, and illicit drug use were significantly intercorrelated, suggesting the presence of a "syndemic" among these HIV-related behavioral health risks. In multivariable analyses controlling for sociodemographic and individual health characteristics, stigma was independently associated with greater levels of unprotected anal intercourse, illicit drug use, and a composite index of the 3 risk behaviors. Findings highlight a need for interventions to address stigma and the social context of unprotected sex, alcohol intoxication, and drug use, which may contribute to HIV risk among transgender women. (C) 2014 Wiley Periodicals, Inc.