Unevenness in Health at the Intersection of Gender and Sexuality: Sexual Minority Disparities in Alcohol and Drug Use Among Transwomen in the San Francisco Bay Area

ABSTRACT

Research on the health of transwomen is largely focused on heterosexual HIV risk. Little is known about the health of sexual minority transwomen. We conducted a secondary cross-sectional analysis of data from a HIV risk and resilience study of transwomen aged 16 to 24 years in the San Francisco Bay Area (N = 259). Prevalence and demographic characteristics of sexual minority transwomen was assessed and logistic regression models were used to examine the relationship between sexual minority status and alcohol and drug use. In logistic regression models, sexual minority transwomen had greater fold odds of heavy episodic drinking and illicit prescription drug use compared to their heterosexual counterparts, controlling for race/ethnicity, age, income, nativity, hormone status, and history of feminization procedures. These results suggest that sexual minority status may be an important social determinant of health among gender minorities. Populations of transwomen are heterogeneous; effective interventions must consider sexual minority status.

KEYWORDS:

• Alcohol use
• health disparities
• LGBT health
• substance use
• transgender
• transwomen
• young adults

Acknowledgments

All authors contributed to the interpretation of data and revising the manuscript for important intellectual content. Dr. Arayasirikul led the development of the manuscript, conducted the statistical analysis, and conceived the data analysis plan. Mr. Pomart and Drs. Raymond and Wilson contributed to the manuscript development. Dr. Wilson conceived and designed the parent longitudinal cohort study for this baseline data analysis. The authors would like to thank all participants in the SHINE study.

Funding

This study was funded by the National Institute of Mental Health (R01MH095598). The lead author was supported by the National Institute on Alcohol Abuse and Alcoholism Graduate Research Training on Alcohol Problems (T32AA007240). This study’s funding source had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Additional information

Funding

This study was funded by the National Institute of Mental Health (R01MH095598). The lead author was supported by the National Institute on Alcohol Abuse and Alcoholism Graduate Research Training on Alcohol Problems (T32AA007240). This study’s funding source had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.