AIDS and Behavior

, Volume 21, Issue 12, pp 3328–3335 | Cite as

Ethnicity, Sex Work, and Incident HIV/STI Among Transgender Women in New York City: A Three Year Prospective Study

  • Larry A. Nuttbrock
  • Sel J. Hwahng
Original Paper


In conjunction with a 3-year prospective study of 199 transgender women from the New York City Area, we attempted to better understand why non-Whites are much more likely than Whites to become HIV infected. We first assessed associations of ethnicity with sex work, sexual risk behavior for HIV, and biologically-determined HIV/STI, and then assessed the extent to which these ethnic differences are explained by socioeconomic factors, immigration status, and sexual orientation. Statistical techniques included generalized estimating equations and Cox proportional hazards. As expected, compared to Whites, Blacks and Hispanics were more involved in the sex trade, more likely to report unprotected receptive anal intercourse, and as a result, more likely to become HIV/STI infected. All of these associations were mediated by androphilia, and to a lesser extent androphilia/gynephilia. Sexual orientation is a significant but little recognized factors associated with new cases of HIV/STI among transgender women of color.


Transgender women Incident HIV/STI Ethnicity 



This research was funded by R01 DA 018080 from the National Institute of Drug Abuse (NIDA) (Larry Nuttbrock, Principal Investigator).

Compliance with Ethical Standards

Conflict of Interest

Both authors declare that they have no conflict of interests pertaining to this research.

Ethical Approval

Research protocols for this research were approved and monitored by the Institutional Review Board (IRB) at National Development and Research Institutes (NDRI. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institution and/or national research committee and with the 1964 Helsinki declaration and its latter amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants in this study.


  1. 1.
    Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevention, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Pub Health. 2001;91:915–21.CrossRefGoogle Scholar
  2. 2.
    Kellog TA, Clements-Nolle K, Kelley J. Incidence of human immunodeficiency virus among male-to-female transgendered persons in San Francisco. J Acquir Immune Defic Syndr. 2001;28(4):380–4.CrossRefGoogle Scholar
  3. 3.
    Herbst JH, Jacobs ED, Finlayson TJ, et al. Estimating HIV prevalence and risk behaviors in transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(6):1–17.CrossRefPubMedGoogle Scholar
  4. 4.
    Nuttbrock LA, Hwahng S, Bockting WO, et al. Lifetime risk factors for HIV/STI infections among male to female transgender persons. J Acquir Immune Defic Syndr. 2009;52(3):417–21.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Elifson KW, Boles J, Posey E. Male transvestite prostitutes and HIV risk. Am J Pub Health. 1993;83:260–2.CrossRefGoogle Scholar
  6. 6.
    Gattari P, Spizzochino C, Valenzi C, et al. Behavioral patterns and HIV infection among drug using transvestites practicing prostitution in Rome. AIDS. 1992;4(1):83–7.CrossRefGoogle Scholar
  7. 7.
    Inciardi JA, Surratt J, Felles RR, et al. Sex, drugs, and the culture of transvestimo in Rio de Janeiro. In: Bockting W, Kirk S, editors. Transgender and HIV: risks, prevention and care. New York: Haworth; 2001.Google Scholar
  8. 8.
    Operario D, Soma T, Underhill K. Sex work and HIV status among transgender women: systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2008;48(1):97–103.CrossRefPubMedGoogle Scholar
  9. 9.
    Simon PA, Reback CJ, Bem CC. HIV prevalence and incidence among male-to-female transsexuals receiving prevention services in Los Angeles County. AIDS. 2000;14(18):2953–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Baral SD, Poteat T, Stromdahl S, et al. World wide burden of HIV in transgender women: a systematic review and meta analysis. Lancet Infect Dis. 2013;13(3):216–22.CrossRefGoogle Scholar
  11. 11.
    Nemoto T, Operario D, Keatley J, et al. HIV risk behaviors among male-to-female transgender persons of color in San Francisco. Am J Pub Health. 2004;94:1193–9.CrossRefGoogle Scholar
  12. 12.
    Center of Disease Control and Prevention. Surveillance data for HIV in the US, 2011.…/statistics_20. Retreived 1 Jan 16.
  13. 13.
    Blinded for review. Sex workers, fem queens, and cross-dressers: differential marginalizations, and HIV vulnerabilities among three male-to-female transgender communities in New York City. Sex Res Soc Policy. 2007;4:6–39.CrossRefGoogle Scholar
  14. 14.
    Blinded for Review. Adolescent gender-related abuse, androphilia, and HIV risk among transgender people of color in New York City. J Homosex. 2014;61:691–713.CrossRefGoogle Scholar
  15. 15.
    Infante C, Sosa-Rabi SG, Cuadra SM. Sex work in Mexico: vulnerability of male, travesty, transgender and transsexual sex workers. Cult Health Sex. 2009;11(2):125–37.CrossRefPubMedGoogle Scholar
  16. 16.
    Nadal KL, Davidoff BS, Fujii-Doe W. Transgender women and the sex work industry: roots in systemic, institutional, and interpersonal discrimination. J Trauma Dissociation. 2014;15:169–83.CrossRefPubMedGoogle Scholar
  17. 17.
    Sausa LA, Keatley J, Operario D. Perceived risks and benefits of sex work among transgender women of color in San Francisco. Arch Sex Behav. 2007;36:768–77.CrossRefPubMedGoogle Scholar
  18. 18.
    Weinberg MS, Shaver EM, Williams CJ. Gender sex work in the San Francisco Tenderloin. Arch Sex Behav. 1999;3:503–21.CrossRefGoogle Scholar
  19. 19.
    Wilson EC, et al. Transgender female youth and sex work: HIV risk and a comparison of life factors related to engagement in sex work. AIDS Behav. 2009;13:902–13.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Samons SL. When the opposite sex isn’t. New York: Routledge; 2009.Google Scholar
  21. 21.
    Baggaley R, White RG, Boily M. HIV transmission through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39:1048–63.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Nuttbrock LA, Bockting WO, Rosenblum A, et al. Gender abuse, depressive symptoms, and HIV/STI among male-to-female transgender persons: a three year prospective study. Am J Public Health. 2013;103:300–7.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kulick D. Travesti, sex, gender and culture among Brazilian transgendered prostitutes. Chicago: University of Chicago Press; 1998.CrossRefGoogle Scholar
  24. 24.
    Prieur A. Mema’s house: on transvestites, queens, and machos. Chicago: University of Chicago Press; 1998.Google Scholar
  25. 25.
    Baily JM. What is sexual orientation and do women have one? In: Hope DA, editor. Contemporary perspectives on lesbian, gay, and bisexual identity, vol. 54. Lincoln: University of Nebraska Press; 2009. p. 1143–63.Google Scholar
  26. 26.
    Diamond LM. Sexual fluidity: understanding women’s love and desire. Cambridge: Harvard University Press; 2008.Google Scholar
  27. 27.
    Parker RG. Bodies, pleasure, and passion: sexual culture in contemporary Brazil. Boston: Beacon Press; 1991.Google Scholar
  28. 28.
    Pinkerton SD, Layde PM. For the NIMH multisite HIV prevention trial group. STIs as proxies for HIV infection. Sex Trans Dis. 2002;29(5):298–307.CrossRefGoogle Scholar
  29. 29.
    Doezema D, Hepworth E, Young SA, Arguelles CA, Berllman JC, Tandberg D. Low prevalence of Chlamydia trachomatis by urine ligase chain reaction in women patients in the emergency department. Acad Emerg Med. 2002;9(6):646–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Hardin JR, Hilbe JR. Generalized estimating equations. 2nd ed. New York: CRC Press; 2012.Google Scholar
  31. 31.
    StataCorp. Stata statistical software: Release 9. College Station, TX: StataCorp LP.Google Scholar
  32. 32.
    Cleves M, Gutienez R, Gould W, Marchenko Y. An introduction to survival analysis using stata. 2nd ed. College Station: Stata Corp LP; 2008.Google Scholar
  33. 33.
    Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic and statistical considerations. 1996. J Pers Soc Psychol. 1996;57:1173–82.Google Scholar
  34. 34.
    MacKinnon DP. Introduction to statistical mediation analysis. New York: Lawrence Erlbaum Associates; 2008.Google Scholar
  35. 35.
    Nuttbrock L. A quantitative analysis of sex work among transgender women in New York City (Chap 2). In: Nuttbrock L, editor. Transgender sex work and society. New York, NY: Harrington Park; forthcoming.Google Scholar
  36. 36.
    Poteat J, Wirtz AL, Borguez A, et al. HIV risk and preventive interventions in transgender women sex workers. Lancet. 2015;385:274–86.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.National Development and Research Institutes (NDRI)New YorkUSA
  2. 2.ElmhurstUSA

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