Social Networks and Exchange Sex among Transgender Women

ABSTRACT

Transgender women are more likely to exchange sex than cisgender individuals. This study investigated how social networks were associated with exchange sex among transgender women in Los Angeles County. From July 2015 to September 2016, transgender women (N = 271; “egos”) reported their sexual and substance use behaviors and perceptions of the same behaviors among their peers (N = 2,619; “alters”). Clustered logistic and negative binomial regressions were used to model odds of exchange sex and number of exchange sex partners in the past 6 months, respectively. Transgender women who perceived that any of their peers were engaged in exchange sex were approximately four times more likely to exchange sex themselves and reported three times as many exchange sex partners as those who did not perceive any peers engaged in exchange sex. Perceived ecstasy use among peers was associated with higher odds of exchange sex and more exchange sex partners, whereas perceived marijuana use among peers was associated with lower odds of exchange sex and fewer exchange sex partners. Peer behaviors were strongly associated with both transgender women’s likelihood and rate of engagement in exchange sex. Risk reduction interventions with transgender women should attend to network dynamics that are often overlooked in existing programs.

Acknowledgments

We acknowledge editing support provided by Dhara Patel and Whitney Akabike. We thank all study participants, CAB members, and research team members. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health or other funders.

Additional information

Funding

This study was supported by the National Institute on Drug Abuse, grant #R21DA037816. Dr. Fehrenbacher was supported by a grant from the National Institutes of Health Fogarty International Center and Office of Behavioral and Social Sciences Research awarded to the University of California Global Health Institute at the University of California, San Francisco (D43TW009343), as well as a National Institute of Mental Health grant awarded to the UCLA Semel Institute for Neuroscience and Human Behavior (T32MH109205). Drs. Reback and Fehrenbacher acknowledge additional support from a center grant to the UCLA Center for HIV Identification, Prevention, and Treatment Services from the National Institute of Mental Health (P30MH58107). Dr. Clark acknowledges funding support from the Graduate Division, UCLA Fielding School of Public Health (Fellowship in Epidemiology, #104733842).