HIV risk behaviors and substance use among transgender women in the San Francisco Bay Area

Background: Our previous study found high HIV risk behaviors among transgender women of color in San Francisco. This expansion study aims to understand substance use and HIV risk behaviors among white transgender women in San Francisco and African American transgender women in Oakland, CA. Methods: Trained African American and white transgender interviewers completed structured interviews with 238 participants (120 African American and 118 white; had history of sex work) recruited from identified community venues. Results: Demographics are: mean age (34 years for African Americans and 39 for whites); completed high school (37% of African Americans and 31% of whites); reported HIV positive status (44% of African Americans and 18% of whites). African American transgender women had engaged in riskier behaviors than white;18% of African American and no white participants reported sex under the influence of ecstasy with casual male partners; 36% of African American and 10% of white participants reported sex under the influence of marijuana with customers; 26% of African American and no white participants reported sex under the influence of ecstasy with customers. Lifetime injection drug use among white transgender participants (43%) were higher than African American (11%). Conclusions: African American transgender women in Oakland had engaged in more high risk behaviors than white transgender women in San Francisco, though injection drug use was more prevalent among whites than African Americans. Culturally specific HIV prevention programs are needed for African American transgender women in Oakland who do not have much access to HIV prevention and care programs.