AIDS and Behavior

, Volume 14, Issue 2, pp 351–358 | Cite as

Risk Behaviors and Psychosocial Stressors in the New York City House Ball Community: A Comparison of Men and Transgender Women Who Have Sex with Men

  • Travis Sanchez
  • Teresa Finlayson
  • Christopher Murrill
  • Vincent Guilin
  • Laura Dean
Original Paper


The New York City House Ball community consists of social networks of racial/ethnic minority gay, lesbian or bisexual men and women, and transgender persons. HIV seroprevalence and interview data were obtained from a sample of community members to identify statistical differences in HIV prevalence, risk behavior, and psychosocial stressors between men who have sex with men (MSM) and transgender women. Of 301 MSM and 60 transgender women, 20% were HIV-infected and 73% were unaware of their infection, but rates did not differ by gender. Risk behavior and stressors were common in both groups, but transgender women were more likely to report exchange sex, stigmatization, and stressful life events. High rates of risk behavior and HIV in this special community warrant relevant HIV testing and prevention services. Transgender women in the community may be at even greater risk for HIV infection due to behaviors compounded by substantial psychosocial stressors.


HIV Behavior MSM Gay Transgender 



The community-based participatory research processes used in this project included members of the House Ball community working collaboratively with investigators and administrators from the following organizations: New York State AIDS Institute, New York City Department of Health and Mental Hygiene, Centers of Disease Control and Prevention, Columbia University’s Mailman School of Public Health, Gay Men’s Health Crisis, People of Color in Crisis, and Gay Men of African Descent. This collaborative research was fostered primarily through a companion project, the Technology Exchange and Capacity-Building of Community Health (TEACH) initiative. The TEACH initiative was comprised of 9 partner organizations: AIDS Center of Queens County, Callen-Lorde Community Health Center, Gay Men of African Descent, Gay Men’s Health Crisis, Harlem United, Hetrick Martin Institute, Hispanic AIDS Forum, Minority Task Force on AIDS, and People of Color in Crisis. Individual participants of the TEACH initiative included the organizations’ executive directors, prevention program mangers and 31 community-based interns. A majority of the TEACH interns worked as field staff for the study and were core members of, or socially connected to, the NYC House Ball community.


  1. 1.
    Catania JA, Osmond D, Stall RD, et al. The continuing HIV epidemic among men who have sex with men. Am J Public Health. 2001;91(6):907–14.CrossRefPubMedGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention. HIV/AIDS among racial/ethnic minority men who have sex with men: United States, 1989-1998. Morb Mortal Wkly Rep. 2000;49(1):4–9.Google Scholar
  3. 3.
    Torian LV, Makki HA, Menzies IB, Murrill CS, Weisfuse IB. HIV infection in men who have sex with men, New York City Department of Health sexually transmitted disease clinics, 1990–1999: a decade of serosurveillance finds that racial disparities and associations between HIV and gonorrhea persist. Sex Transm Dis. 2002;29(2):73–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention. HIV incidence among young men who have sex with men–seven US cities, 1994-2000. Morb Mortal Wkly Rep. 2001;50(21):440–4.Google Scholar
  5. 5.
    Mackellar D, Valleroy L, Karon J, Lemp G, Janssen R. The young men’s survey: methods for estimating HIV seroprevalence and risk factors among young men who have sex with men. Public Health Rep. 1996;3(Supplement 1):139–44.Google Scholar
  6. 6.
    Valleroy LA, MacKellar DA, Karon JM, et al. HIV prevalence and associated risks in young men who have sex with men. Young men’s survey study group. JAMA. 2000;284(2):198–204.CrossRefPubMedGoogle Scholar
  7. 7.
    Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(1):1–17.CrossRefPubMedGoogle Scholar
  8. 8.
    Green E, Petersen E. Trans and sexuality terminologies. Available at: Accessed August 17, 2009.
  9. 9.
    Lombardi EL, van SG. Correcting deficiencies in HIV/AIDS care for transgendered individuals. J Assoc Nurses AIDS Care. 2000;11(5):61–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Kenagy GP. HIV among transgendered people. AIDS Care. 2002;14(1):127–34.CrossRefPubMedGoogle Scholar
  11. 11.
    Kenagy GP. Transgender health: findings from two needs assessment studies in Philadelphia. Health Soc Work. 2005;30(1):19–26.PubMedGoogle Scholar
  12. 12.
    Nemoto T, Operario J, Keatley J, Villegas D. Social context of HIV risk behaviours among male-to-female transgender of colour. AIDS Care. 2004;16(6):724–35.CrossRefPubMedGoogle Scholar
  13. 13.
    Podhurst L, Credle J. HIV/AIDS risk reduction strategies for Gay youth of color in the “house” community. In: Proceedings of the International Conference on AIDS; 1998: Geneva, Switzerland: International AIDS Society; 1998. 913.Google Scholar
  14. 14.
    Bontempo DE, D’Augelli AR. Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. J Adolesc Health. 2002;30(5):364–74.CrossRefPubMedGoogle Scholar
  15. 15.
    Chauncey G. Gay New York: gender, urban culture, and the making of the gay male world 1890–1940. New York: Basic Books; 1994.Google Scholar
  16. 16.
    Herek GM, Gillis JR, Cogan JC. Psychological sequelae of hate-crime victimization among lesbian, gay, and bisexual adults. J Consult Clin Psychol. 1999;67(6):945–51.CrossRefPubMedGoogle Scholar
  17. 17.
    Kruks G. Gay and lesbian homeless/street youth: special issues and concerns. J Adolesc Health. 1991;12(7):515–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310–57.CrossRefPubMedGoogle Scholar
  19. 19.
    Diaz RM, Ayala G, Bein E, Henne J, Marin BV. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am J Public Health. 2001;91(6):927–32.CrossRefPubMedGoogle Scholar
  20. 20.
    Myers HF, Javanbakht M, Martinez M, Obediah S. Psychosocial predictors of risky sexual behaviors in African American men: implications for prevention. AIDS Educ Prev. 2003;15(1 Suppl A):66–79.CrossRefPubMedGoogle Scholar
  21. 21.
    Yoshikawa H, Wilson PA, Chae DH, Cheng JF. Do family and friendship networks protect against the influence of discrimination on mental health and HIV risk among Asian and Pacific Islander gay men? AIDS Educ Prev. 2004;16(1):84–100.CrossRefPubMedGoogle Scholar
  22. 22.
    Centers for Disease Control and Prevention. HIV-related tuberculosis in a transgender network–Baltimore, Maryland and New York City area, 1998-2000. Morb Mortal Wkly Rep. 2000;49(15):317–20.Google Scholar
  23. 23.
    Leung MW, Yen IH, Minkler M. Community based participatory research: a promising approach for increasing epidemiology’s relevance in the 21st century. Int J Epidemiol. 2004;33(3):499–506.CrossRefPubMedGoogle Scholar
  24. 24.
    Murrill CS, Liu KL, Guilin V, et al. HIV prevalence and associated risk behaviors in New York City’s house ball community. Am J Public Health. 2008;98(6):1074–80.CrossRefPubMedGoogle Scholar
  25. 25.
    Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press; 1965.Google Scholar
  26. 26.
    Herek GM, Glunt EK. Identity and community among gay and bisexual men in the AIDS era: preliminary findings from the Sacramento Men’s health study. In: Herek GM, Greene B, editors. AIDS, identity, and community: the HIV epidemic and Lesbians and gay men. Thousand Oaks, CA: Sage Publications; 1995. p. 55–84.Google Scholar
  27. 27.
    Martin JL, Dean L. A 7-year (1985–1991) longitudinal study of mental health effects of AIDS on at-risk homosexual men. Unpublished manuscript: AIDS research unit, division of sociomedical sciences. New York: Columbia University Mailman School of Public Health: New York; 1995.Google Scholar
  28. 28.
    Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38–56.CrossRefPubMedGoogle Scholar
  29. 29.
    Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.CrossRefGoogle Scholar
  30. 30.
    Stall RD, Hayes RB, Waldo CR, Ekstrand M, McFarland W. The gay 90’s: a review of the research in the 1990’s on sexual behavior and HIV risk among men who have sex with men. AIDS. 2000;14:S101–14.CrossRefPubMedGoogle Scholar
  31. 31.
    Hallfors DD, Iritani BJ, Miller WC, Baur DJ. Sexual and drug behavior patterns and HIV and STD racial disparities: the need for new directions. Am J Public Health. 2007;97:125–32.CrossRefPubMedGoogle Scholar
  32. 32.
    Centers for Disease Control and Prevention. HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men–five U.S. cities, June 2004-April 2005. MMWR. 2005;54(24):597–601.Google Scholar
  33. 33.
    Koblin BA, Torian LV, Guilin V, Ren L, MacKellar DA, Valleroy LA. High prevalence of HIV infection among young men who have sex with men in New York City. AIDS. 2000;14(12):1793–800.CrossRefPubMedGoogle Scholar
  34. 34.
    Sanchez T, Finlayson T, Drake A, et al. Human immunodeficiency virus (HIV) risk, prevention, and testing behaviors–United States, National HIV behavioral surveillance system: men who have sex with men. Morb Mortal Wkly Rep. 2006;55(SS-6):1–16.Google Scholar
  35. 35.
    Preston DB, D’Augelli AR, Kassab CD, Starks MT. The relationship of stigma to the sexual risk behavior of rural men who have sex with men. AIDS Educ Prev. 2007;19(3):218–30.CrossRefPubMedGoogle Scholar

Copyright information

© GovernmentEmployee: Centers for Disease Control and Prevention 2009

Authors and Affiliations

  • Travis Sanchez
    • 1
  • Teresa Finlayson
    • 1
  • Christopher Murrill
    • 2
  • Vincent Guilin
    • 3
  • Laura Dean
    • 4
  1. 1.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.New York City Department of Health and Mental HygieneHIV Epidemiology ProgramNew YorkUSA
  3. 3.Gay Men’s Health CrisisNew YorkUSA
  4. 4.Mailman School of Public HealthColumbia UniversityNew YorkUSA

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