"Workin' It:" Transgender Women and the Social-Cultural Context of HIV/AIDS Risk

Christopher W Roebuck, University of California, Berkeley
Social and Behavioral

HIV/AIDS constitutes a dire medical and social emergency for MTF transgender women in California. In Los Angeles county, HIV prevalence in the MTF transgender population is reported to be 22%, and in San Francisco, 35%. Recognizing that HIV risk is shaped by synergetic biological, social-structural, and individual factors, this study proposes an anthropological investigation of the social and cultural context of HIV/AIDS risk among transgender women in San Francisco. It has four aims: 1) To identify the significant social, political, economic, and demographic factors that place transgender women at elevated risk for HIV/AIDS; 2) To examine the social support networks of transgender women and assess the impact of these networks on HIV/AIDS risk; 3) To document the views and opinions of transgender women and their healthcare providers towards current HIV/AIDS programs; 4) To identify the HIV/AIDS prevention and healthcare needs of transgender women. The primary research participants include at least 45 transgender women in San Francisco, a community comprised of many immigrant women from Mexico and Southeast Asia. Secondary subjects include at least 25 members of their social networks - partners, friends, family members - and at least 25 healthcare providers. The research design incorporates a multi-sited ethnography, utilizing the recruitment and sampling methods of snowballing, venue-based, and respondent driven recruitment of peers. Field-sites include medical clinics, social support agencies, community and social venues, and fieldwork in a low-income urban neighborhood that is home, worksite, and social center for many immigrant transgender women. To obtain a comprehensive picture of the social and cultural context of HIV risk, the study employs the ethnographic methods of extensive participant-observation, qualitative surveys, in-depth interviews/collection of life histories, and qualitative analysis of data. This study responds to California's HIV/AIDS needs in 3 significant ways. 1) As defined by California's DHS, transgender individuals and immigrant communities constitute two vulnerable populations in California that are disproportionately at risk for HIV/AIDS. 2) As data from Los Angeles and San Francisco report, the MTF transgender population is experiencing some of the highest HIV prevalence rates for a vulnerable community ever recorded in the history of the HIV/AIDS epidemic in the United States. 3) Given San Francisco's unique role as an internationally recognized center for gender and sexual diversity, it is imperative that comprehensive qualitative data is collected describing the diverse HIV/AIDS needs of those who migrate to the City due to gender and sexual identities. Thus, this study will increase knowledge about the life circumstances of individuals who are members of two vulnerable and marginalized communities in California, and provide insight into the international dynamics at play in California's HIV/AIDS crisis, particularly San Francisco's unique position in the global epidemic. These research findings will support the design of culturally appropriate and competent HIV/AIDS services for the diverse population of transgender women who are presently underserved by HIV/AIDS efforts in the State. This study is one component of a broader effort to reduce the burden of HIV/AIDS in a Californian population that is not only disproportionately effected by the epidemic, but misunderstood and stereotyped.