Upload
mora
View
50
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Trans-Female youth, development, and HIV risk. Erin C. Wilson, DrPH - San Francisco Department of Public Health, [email protected]. What we know. Trans-female youth are at high risk for HIV Sample HIV prevalence rates of 19% and 22% (Wilson, 2009; Garofalo, 2006) - PowerPoint PPT Presentation
Citation preview
TRANS-FEMALE YOUTH, DEVELOPMENT, AND HIV RISKErin C. Wilson, DrPH- San Francisco Department of Public Health, [email protected]
What we know Trans-female youth are at high risk for
HIV Sample HIV prevalence rates of 19% and
22% (Wilson, 2009; Garofalo, 2006) In San Francisco, there is a rise in AIDS
diagnoses among transfemales under 30
Contextual factors for HIV risk
• Mental health• Social isolation• Economic
marginalization• Incarceration• Health care needs• Misperceptions of risk• Abuse
Gender identity development and correlates?
Adults factors shared by youth Unique to youth
Gender identity formation among children
Gender identity is typically developed in three stages:
Construction (ages 0–5 years) Consolidation (ages 5–7 years) Integration (ages 7 years and up)
Transgender identity adds additional burden
Dissonance
Exploration
Disclosures
*Identity resolutio
n
* Seth Pardo, Cornell
What all youth need to thrive Physical and
psychological safety Appropriate
structures Supportive
relationships Connectedness,
caring, support and responsiveness
Opportunities to belong and for meaningful inclusion
Positive social norms Support for efficacy
and mattering that includes enabling, responsibility and meaningful challenges
Opportunities for skill building
Integration of family, school and community efforts
Eccles et. al., 2002
Longitudinal study of trans-female youth in the San Francisco, CA Bay Area
Phase I. 8 focus group discussions conducted with
trans-female youth ages 16-24 to investigate of protective factors that promote resilience
*Study funded by the National Institute of Mental Health
Challenges trans-female youth face in gender identity development
Self acceptance and ability to come out
Models for *authentic transitioning and reliable sources of information on gender
Difficulty finding sexual partners
Trauma from gender-related violence and harassment
Accessible medical services to support gender identity development
Lack of familial support Lack of reliable
information and institutional support in schools
Individual Structural
HIV risks may be related to development and intersecting risks
Race/Ethnicity
Youth
HIV
Sexual Behavior
Youth accounte
d for 39% of all new
infections in 2009
Data from 2009 show that
African Americans
accounted for 50% of all HIV
infectionsMSM
account for 49% of the
US population living with
HIV
Negative developmental experiences related to intersections & trans identity put transyouth at risk for….
Low self esteem Negative self-image Physical Violence (a precursor or
outcome) Mental health issues- notably
depression, but some evidence of PTSD Suicide ??
Poor outcomes identified in TRYP data
Individuals Factors Structural Factors
Substance Use (90%) used)
Job discrimination (49%)
Homelessness (43%) Dropped out of school due to gender discrimination (24%)
Victimization by partner (35%)
Incarceration (52% have ever been incarcerated)
Institutionalization (26%)
HIV positive Youth
HIV+ 19%
HIV- 81%%
Results of last HIV test (n=151)
The seroprevalence rate among those who ever engaged in sex work was 23.2% compared to 5.9% among those who never engaged in sex work (p=0.0375)
Yes67%
No33%
*p-value 0.027
Sex Work – Youth
Sex work- TRYP study 2007
What are factors that differentiate youth with a history of sex work?
Higher likelihood of having HIV (23% vs. 6%). Lower educational attainment More homelessness More likely to have been incarcerated More likely to have been abused by a partner Have less overall social support More likely to be victimized in the community More likely to have experienced discrimination
in school environments More likely to have been committed to inpatient
facilities
Protective Factors that promote healthy development – SHINE study Support
Connectedness to parents
Friends are hard to come by but critical
Jobs Opportunity for
responsibility Skill building
Access to gender-related care Hormones and laser
treatment are key for those starting to transition
breast augmentation critical for older youth
Independence/Distance from trans community
*YouTube and other places in the blogosphere Stories of transitioning and
other information Decreased isolation
Jr. college and university environment
Typical of all young people Unique to trans youth
Gender-related needs must also be met in HIV prevention for trans-female youth
Healthy gender identity develop
ment
Mitigation of
structural risks
Supports- parents, schools, peers,
medical care
HIV preventi
on
Existing Interventions/Programs
Tranny Rockstar Project abstract
State of Prevention Science in HIV
Knowing one’s HIV status PrEP Treatment and Viral load suppression
What we need to know Youth development model for transgender youth
Interventions possible within a paradigm of treatment as prevention?
What supports are necessary and essential to promoting healthy development among transyouth
Chicken or Egg? Determine which precursors put youth at most risk Determine most critical supports that can mitigate
the effect of deleterious precursors Identify resilience and build upon it in the
development of interventions