Precursors for sexual risk reduction in the transgender (Mahuwahine) community in Hawaii

Background. Research on insular transgendered communities is sparse. The complex intersections of sexuality, health, and social systems (schools, health organizations, and churches) contribute to the cyclical process between poor health and employment outcomes. With the Male to Female transgender, or mahuwahine community, discrimination and substance use may often leads to unsafe employment like sex work leading to outcomes like STDs, HIV/ AIDS. This project utilizes surveys to further the mahuwahine research by locating community members to understand their needs for education, health, and employment services.

Methods. The Transgender Survey was co-constructed by a researcher and the mahuwahine community. The Survey was administered over the phone by a ¬¬mahuwahine person, an insider, given cultural sensitivities with the community.

Results. There were 168 were mahuwahine participants with the majority who identified as Native Hawaiian. From the participants, 72% participated in sex work; 84% of these participants, however, currently relied on legal employment or their own businesses for employment.

Conclusions. It is imperative to partner with mahuwahines and include their perspectives in the research design and process. This resulted in the high number of participation. Qualitative methods, however, (e.g. interviews) can provide deeper insight to better understand the mahuwahine community's life experiences on health outcomes (HIV/ AIDS, cancer, tobacco use), discrimination, employment, and education. This data serves as the foundation to mahuwahine community's existence in Hawaii to foster culturally sensitive education in the workplace, healthcare systems, schools, and religious institutions to decrease disparities in health.