Sex workers, fem queens, and cross-dressers: Differential marginalizations and HIV vulnerabilities among three ethnocultural male-to-female transgender communities in New York City

  • Sel Julian Hwahng
  • Larry Nuttbrock
Special Issue Article


This article describes 3 distinct ethnocultural male-to-female transgender communities in New York City: the low-income African American/Black1 and Latina(o) House Ball community; low-income, often undocumented immigrant Asian sex workers; and middle-class White cross-dressers. These communities are highly socially isolated from each other and are more connected to their ethnocultural contexts than to an abstract and shared transgender identity. Whereas previous research either has viewed male-to-female transgender people as one monolithic group or has separated them into abstract racial categories unconnected to their communities and lifestyles, this article positions them within specific social networks, cultures, neighborhoods, and lifestyles. With regard to HIV vulnerabilities, violence, and rape, House Ball community members seemed to engage in the riskiest form of survival sex work, whereas Asian sex workers seemed to engage in moderate-risk survival sex work. White cross-dressers seemed to engage in very low-risk recreational sex work.2

Key words

sex work House Ball community Asian immigrants social networks ethnocultural community contexts 


  1. Aggleton, P. (Ed.). (1999). Men who sell sex: International perspectives on male prostitution and HIV/AIDS. Philadelphia: Temple University Press.Google Scholar
  2. Aguirre, A., Jr., & Turner, J. (1998). American ethnicity: The dynamics and consequences of discrimination. New York: McGraw-Hill.Google Scholar
  3. Amaro, H. (1995). Love, sex, and power: Considering women’s realities in HIV prevention. American Psychologist, 50, 437–447.CrossRefPubMedGoogle Scholar
  4. Amaro, H., & Raj, A. (2000). On the margin: Power and women’s HIV risk reduction strategies. Sex Roles, 42, 723–750.CrossRefGoogle Scholar
  5. Amaro, H., Raj, A., & Reed, E. (2001). Women’s sexual health: The need for feminist analyses in public health in the decade of behavior. Psychology of Women Quarterly, 25, 324–334.CrossRefGoogle Scholar
  6. American Boyz. (1996–2001). Annual True Spirit Conference. True Spirit conference programs. Washington, DC: Author.Google Scholar
  7. Baker, L. M., Case, P., & Policicchio, D. L. (2003). General health problems of inner-city sex workers: A pilot study. Journal of the Medical Library Association, 91, 67–71.PubMedGoogle Scholar
  8. Becker, H. S. (1998). Tricks of the trade: How to think about your research while you’re doing it. Chicago: University of Chicago Press.Google Scholar
  9. Bhattacharya, G. (2004). Health care seeking for HIV/AIDS among South Asians in the United States. Health & Social Work, 29, 106–115.Google Scholar
  10. Bockting, W. O., Robinson, B. E., & Rosser, B. R. S. (1998). Transgender HIV prevention: A qualitative needs assessment. AIDS Care, 10, 505–526.CrossRefPubMedGoogle Scholar
  11. Bonilla-Silva, E., & Glover, K. S. (2004). “We are all Americans”: The Latin Americanization of race relations in the United States. In M. Krysan & A. E. Lewis (Eds.), The changing terrain of race and ethnicity (pp. 149–185). New York: Russell Sage Foundation Publications.Google Scholar
  12. Brooks, P. (Director), & Bocahut, L. (Director). (1998). Woubi chéri. [Motion picture]. Côte d’Ivoire and France: Dominant 7.Google Scholar
  13. Carrasquillo, O., Carrasquillo, A. I., & Shea, S. (2000). Health insurance coverage of immigrants living in the United States: Differences by citizenship status and country of origin. American Journal of Public Health, 90, 917–923.CrossRefPubMedGoogle Scholar
  14. Chang, J. (1993). Race, class, conflict, and empowerment: On Ice Cube’s “Black Korea.” Amerasia Journal, 19(2), 87–107.Google Scholar
  15. Choy, J., Foote, D., Bojanowski, J., Yamashita, R., & Vichinsky, E. (2000). Outreach strategies for Southeast Asian communities: Experience, practice, suggestions for approaching Southeast Asian immigrant and refugee communities to provide thalassemia education and trait testing. Journal of Pediatric Hematology/Oncology, 22, 588–592.CrossRefPubMedGoogle Scholar
  16. Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001). HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health, 91, 915–921.CrossRefPubMedGoogle Scholar
  17. Cohen, C. J. (1999). The boundaries of Blackness: AIDS and the breakdown of Black politics. Chicago: University of Chicago Press.Google Scholar
  18. Connell, R. W. (1987). Gender & power: Society, the person and sexual politics. Palo Alto, CA: Stanford University Press.Google Scholar
  19. Connell, R. W. (1995). Masculinities. Los Angeles: University of California Press.Google Scholar
  20. Costa, L., & Matzner, A. J. (2007). Male bodies, women’s souls: Personal narratives of Thailand’s transgendered youth. New York: Haworth Press.Google Scholar
  21. Demme, J. (Director), Harris, T. (Writer), & Tally, T. (1991). The silence of the lambs [Motion picture]. United States: Orion Pictures.Google Scholar
  22. Deren, S., Sanchez, J., Shedlin, M., Davis, W. R., Beardsley, M., Des Jarlais, D., et al. (1996). HIV risk behaviors among Dominican brothel and street prostitutes in New York City. AIDS Education and Prevention, 8, 444–456.PubMedGoogle Scholar
  23. Deren, S., Shedlin, M., Davis, W. R., Clatts, M. C., Balcorta, S., Beardsley, M., et al. (1997). Dominican, Mexican, and Puerto Rican prostitutes: Drug use and sexual behaviors. Hispanic Journal of Behavioral Sciences, 19, 202–213.CrossRefPubMedGoogle Scholar
  24. Diaz, R. (1998). Latino gay men and HIV: Culture, sexuality, and risk behavior. New York: Routledge.Google Scholar
  25. Elifson, K. W., Boles, J., Posey, E., Sweat, M., & Darrow, W. (1993). Male transvestite prostitutes and HIV risk. American Journal of Public Health, 83, 260–262.CrossRefPubMedGoogle Scholar
  26. Feldman, J., & Bockting, W. (2003, July). Transgender health. Minnesota Medicine, 86, 25–33.PubMedGoogle Scholar
  27. Gentry, Q. M., Elifson, K., & Sterk, C. (2005). Aiming for more relevant HIV risk reduction: A Black feminist perspective for enhancing HIV intervention for lowincome African American women. AIDS Education and Prevention, 17, 238–252.CrossRefPubMedGoogle Scholar
  28. Goel, M. S., Wee, C. C., McCarthy, E. P., Davis, R. B., Ngo-Metzger, Q., & Phillips, R. S. (2003). Racial and ethnic disparities in cancer screening: The importance of foreign birth as a barrier to care. Journal of General Internal Medicine, 18, 1028–1035.CrossRefPubMedGoogle Scholar
  29. Gorman, E. M., Barr, B.-D., Hansen, A., Robertson, B., & Green, C. (1997). Speed, sex, gay men, and HIV: Ecological and community perspectives. Medical Anthropology Quarterly, 11, 505–515.CrossRefPubMedGoogle Scholar
  30. Gwadz, M. V., Clatts, M. C., Leonard, N. R., & Goldsamt, L. (2004). Attachment style, childhood adversity, and behavioral risk among young men who have sex with men. Journal of Adolescent Health, 34, 402–413.PubMedGoogle Scholar
  31. Hale, C. J. (1997, Fall/Winter). Leatherdyke boys and their daddies: How to have sex without women or men. Social Text, 52-53, 223–236.CrossRefGoogle Scholar
  32. Hembree, W., & Horowitz, D. (2007). Transgender in the New York state correctional system: Clinical and legal trials and tribulations. New York City: New York State Psychiatric Institute & Department of Psychiatry, Columbia University.Google Scholar
  33. Henríquez, P. (Director). (2002). Juchitán, queer paradise [Motion picture]. Chile and Canada: Filmakers Library.Google Scholar
  34. Higgins, M. J., & Coen, T. L. (2000). Streets, bedrooms & patios: The ordinariness of diversity in urban Oaxaca. Austin: University of Texas Press.Google Scholar
  35. Hwahng, S. J. (2007). Transecting health disparities research: Racial stratifications and social marginalizations among three ethnocultural male-to-female transgender communities in New York City. Manuscript submitted for publication.Google Scholar
  36. Jacobs, S.-E., Thomas, W., & Lang, S. (Eds.). (1997). Two-spirit people: Native American gender identity, sexuality, and spirituality. Urbana: University of Illinois Press.Google Scholar
  37. Jang, M., Lee, E., & Woo, K. (1998). Income, language, and citizenship status: Factors affecting the health care access and utilization of Chinese Americans. Health & Social Work, 23, 136–145.Google Scholar
  38. Johnson, M. (1997). Beauty andpower: Transgendering and cultural transformation in the southern Philippines. New York: Berg.Google Scholar
  39. Kang, E., Rapkin, B. D., Remien, R. H., Mellins, C. A., & Oh, A. (2005). Multiple dimensions of HIV stigma and psychological distress among Asians and Pacific Islanders living with HIV illness. AIDS and Behavior, 9, 145–154.CrossRefPubMedGoogle Scholar
  40. Kang, E., Rapkin, B. D., Springer, C., & Kim, J. H. (2003). The “demon plague” and access to care among Asian undocumented immigrants living with HIV disease in New York City. Journal of Immigrant Health, 5, 49–58.CrossRefPubMedGoogle Scholar
  41. Kellogg, T. A., Clements-Nolle, K., Dilley, J., Katz, M. H., & McFarland, W. (2001). Incidence of human immunodeficiency virus among male-to-female transgendered persons in San Francisco. Journal of Acquired Immune Deficiency Syndromes, 28, 380–384.PubMedGoogle Scholar
  42. Kenagy, G. P. (2002). HIV among transgender people. AIDS Care, 14, 127–134.CrossRefPubMedGoogle Scholar
  43. Kenagy, G. P. (2005). Transgender health: Findings from two needs assessment studies in Philadelphia. Health & Social Work, 30, 19–26.Google Scholar
  44. Kenagy, G. P., & Hsieh, C.-M. (2005). The riskless known: Female-to-male transgender persons’ vulnerability to HIV infection. AIDS Care, 17, 195–207.CrossRefPubMedGoogle Scholar
  45. King, D. (1988). Multiple jeopardy, multiple consciousness: The context of a Black feminist ideology. Signs: Journal of Women in Culture and Society, 14, 42–72.CrossRefGoogle Scholar
  46. Kulick, D. (1998). Travesti: Sex, gender and culture among Brazilian transgendered prostitutes. Chicago: University of Chicago Press.Google Scholar
  47. Kurtz, S. P., Surratt, H. L., Kiley, M. C., & Inciardi, J. A. (2005). Barriers to health and social services for street-based sex workers. Journal of Health Care for the Poor and Underserved, 16, 345–361.CrossRefPubMedGoogle Scholar
  48. Li, A., & Covinski, K. (2003). Citizenship status is an important determinant of health care disparity. Journal of General Internal Medicine, 18(Suppl. 1), 179.Google Scholar
  49. Lombardi, E. (2001). Enhancing transgender health care. American Journal of Public Health, 91, 869–872.CrossRefPubMedGoogle Scholar
  50. Lowe, L. (1996). Immigrant acts: On Asian American cultural politics. Durham, NC: Duke University Press.Google Scholar
  51. Lyketsos, C. G., Nestadt, G., Cwi, J., Heithoof, K., & Eaton, W. W. (1994). The Life Chart Interview: A standardized method to describe the course of psychopathology. International Journal of Methods in Psychiatric Research, 4, 143–155.Google Scholar
  52. Marger, M. N. (2002). Social inequality patterns and processes. New York: McGraw-Hill.Google Scholar
  53. Marmot, M. G. (2004). Status syndrome: How your social standing directly affects your health and life expectancy. New York: Henry Holt and Company.Google Scholar
  54. Martinot, S. (2003). The rule ofracialization: Class, identity, governance. Philadelphia: Temple University Press.Google Scholar
  55. Modan, B., Goldschmidt, R., Rubinstein, E., Vonsover, A., Zinn, M., Golan, R., et al. (1992). Prevalence of HIV antibodies in transsexual and female prostitutes. American Journal of Public Health, 82, 590–592.CrossRefPubMedGoogle Scholar
  56. Murray, S. O., & Roscoe, W. (1997). Islamic homosexualities: Culture, history, and literature. New York: New York University Press.Google Scholar
  57. Murray, S. O., & Roscoe, W. (Eds.). (1998). Boy-wives and female-husbands: Studies in African homosexualities. New York: St. Martin’s Press.Google Scholar
  58. Murrill, C., Guilin, V., Dean, L., Liu, K.-L., Junquera, Y., Ascencio, R., et al. (2005). HIV prevalence and risk behaviors among persons active in the New York City House Ball community. New York: New York City Department of Health and Mental Hygiene.Google Scholar
  59. Nanda, S. (1999). Neither man nor woman: The hijras of India. Belmont, CA: Wadsworth.Google Scholar
  60. Nemoto, T., Iwamoto, M., Wong, S., Le, M. N., & Operario, D. (2004). Social factors related to risk for violence and sexually transmitted infections/HIV among Asian massage parlor workers in San Francisco. AIDS and Behavior, 8, 475–483.CrossRefPubMedGoogle Scholar
  61. Nemoto, T., Luke, D., Mamo, L., Ching, A., & Patria, J. (1999). HIV risk behaviours among male-to-female transgenders in comparison with homosexual or bisexual males and heterosexual females. AIDS Care, 11, 297–312.CrossRefPubMedGoogle Scholar
  62. Nemoto, T., Operario, D., Keatley, J., Han, L., & Soma, T. (2004). HIV risk behaviors among male-to-female transgender persons of color in San Francisco. American Journal of Public Health, 94, 1193–1199.CrossRefPubMedGoogle Scholar
  63. Nemoto, T., Operario, D., Keatley, J., Nguyen, H., & Sugano, E. (2005). Promoting health for transgender women: Transgender Resources and Neighborhood Space (TRANS) Programin San Francisco. American Journal of Public Health, 95, 382–384.CrossRefPubMedGoogle Scholar
  64. Nemoto, T., Operario, D., Keatley, J., & Villegas, D. (2004). Social context of HIV risk behaviours among male-to-female transgenders of colour. AIDS Care, 16, 724–735.CrossRefPubMedGoogle Scholar
  65. Nuttbrock, L. (2006). Report on preliminary findings from the Transgender Project. New York: Gender Forum/National Development and Research Institutes.Google Scholar
  66. Nuttbrock, L. A., Rosenblum, A., Magura, S., Villano, C., & Wallace, J. (2004). Linking female sex workers with substance abuse treatment. Journal of Substance Abuse Treatment, 27, 233–239.CrossRefPubMedGoogle Scholar
  67. Omi, M., & Winant, H. (1994). Racial formation in the United States: From the 1960s to the 1990s. New York: Routledge.Google Scholar
  68. Prieur, A. (1998). Mema’s house, Mexico City: On transvestites, queens, and machos. Chicago: University of Chicago Press.Google Scholar
  69. Reddy, G. (2005). With respect to sex: Negotiating hijra identity in South India. Chicago: University of Chicago Press.Google Scholar
  70. Roscoe, W. (1998). Changing ones: Third and fourth genders in Native North America. New York: St. Martin’s Press.Google Scholar
  71. Sevelius, J., Nemoto, T., Keatley, J., Ventura, A., & SenGupta, S. (2005). Female-to-male (FTM) trans-gender health care needs. Paper presented at the American Public Health Association 133rd Annual Meeting & Exposition, Philadelphia, PA.Google Scholar
  72. Simon, P. A., Reback, C. J., & Bemis, C. C. (2000). HIV prevalence and incidence among male-to-female transsexuals receiving HIV prevention services in Los Angeles County. AIDS, 14, 2953–2955.CrossRefPubMedGoogle Scholar
  73. Stephens, T., Scott, C., & Braithwaite, R. (1999). Transsexual orientation in HIV risk behaviors in an adult male prison. International Journal ofSTD & AIDS, 10, 28–31.CrossRefGoogle Scholar
  74. Sterling, T. R., Thompson, D., Stanley, R. L., McElroy, P. D., Madison, A., Moore, K., et al. (2000). A multi-state outbreak of tuberculosis among members of a highly mobile social network: Implications for tuberculosis elimination. The International Journal of Tuberculosis and Lung Disease, 4, 1066–1073.PubMedGoogle Scholar
  75. Strauss, A. L., & Corbin, J. M. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage Publications.Google Scholar
  76. Susser, E., Finnerty, M., Mojtabai, R., Yale, S., Conover, S., Goetz, R., et al. (2000). Reliability of the Life Chart Schedule for assessment of the long-term course of schizophrenia. Schizophrenia Research, 42, 67–77.CrossRefPubMedGoogle Scholar
  77. Sykes, D. L. (1999, January). Transgender people: An “invisible” population. California HIV/AIDS Update, 12, 1–6.Google Scholar
  78. Teh, Y. K. (2002). The mak nyahs: Malaysian male to female transsexuals. Singapore: Eastern Universities Press.Google Scholar
  79. Tirelli, U., Errante, D., & Serraino, D. (1988). HIV-1 seroprevalence in male prostitutes in Northeast Italy. Journal of Acquired Immune Deficiency Syndromes, 1, 414–417.PubMedGoogle Scholar
  80. Tucker, D. (Writer/Director). (2005). Transamerica [Motion picture]. United States: Belladonna Productions.Google Scholar
  81. Valenta, L. J., Elias, A. N., & Domurat, E. S. (1992). Hormone pattern in pharmacologically feminized male transsexuals in the California State prison system. Journal of the National Medical Association, 84, 241–250.PubMedGoogle Scholar
  82. Valera, R. J., Sawyer, R. G., & Schiraldi, G. R. (2001). Perceived health needs of inner-city street prostitutes: A preliminary study. American Journal of Health Behavior, 25, 50–59.PubMedGoogle Scholar
  83. Valle, R. (1988–1989). Outreach to ethnic minorities with Alzheimer’s disease: The challenge to the community. Health Matrix, 6, 13–27.PubMedGoogle Scholar
  84. Weinberg, M. S., Shaver, F. M., & Williams, C. J. (1999). Gendered sex work in the San Francisco Tenderloin. Archives of Sexual Behavior, 28, 503–521.CrossRefPubMedGoogle Scholar
  85. Weiner, A. (1996). Understanding the social needs of streetwalking prostitutes. Social Work, 41, 97–105.PubMedGoogle Scholar
  86. Yahne, C. E., Miller, W. R., Irvin-Vitela, L., & Tonigan, J. S. (2002). Magdalena Pilot Project: Motivational out-reach to substance abusing women street sex workers. Journal of Substance Abuse Treatment, 23, 49–53.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2007

Authors and Affiliations

  1. 1.National Development and Research Institutes Inc.New York
  2. 2.National Development and Research Institutes Inc.Institute for Treatment and Services ResearchNew York

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