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Abstract
Many transgendered women face social, cultural, and economic challenges that result in their reliance on exchange sex to secure needed items. This study compares the HIV seroprevalence and risk behaviors of transgendered women who exchanged sex with those who did not. Of the 244 transgendered women interviewed, those who exchanged sex comprised 58.2% of the sample and were younger (p < .001), less educated (p < .001), and less likely to have or seek health care (p < .001). HIV seroprevalence was higher in those who exchanged sex than those who did not (26.1% versus 16.7%). Those who exchanged sex reported more casual sex partners and were more likely to report sex while high on alcohol and/or drugs, but were also more likely to report condom use. In the multivariate analysis, exchange sex was not associated with increased HIV seroprevalance, but substance use during sex and African-American race were associated with increased seroprevalance. These findings highlight the importance of examining the sexual lives and social circumstances of transgendered women and the necessity of integrating substance abuse treatment into HIV prevention settings.
