Location Matters: Correlates of HIV Risk Behaviors and HIV “Hot Spots” among Transgender Residents of Massachusetts

BACKGROUND: HIV surveillance data indicates that HIV infection typically clusters in specific geographic “hot spot” areas, suggesting the need for inclusion of geographic factors alongside traditional demographic and socio-behavioral risk factors when assessing HIV risk and allocating HIV prevention resources.

METHODS: In 2013, 445 transgender residents of Massachusetts completed an online (88%) and in-person (12%) survey assessing demographics, substance use, and sexual behaviors. A multivariable logistic regression model examined associations between race, alcohol consumption, unprotected sex and residing in Massachusetts “hot-spot” city with the highest HIV/AIDS prevalence.

RESULTS: Participants had a mean age of 32 (SD=12.9), 79% were White, 63% were assigned a female sex at birth, and 18% resided in an HIV hot-spot. About one-third (32%) reported binge drinking in the past 3-months (drinking five+ alcoholic beverages at one time). Eleven percent engaged in receptive anal sex with a male-born partner during their last sexual encounter, of which half indicated that they didn’t use a condom. Factors significantly associated with the increased odds of living in an HIV hot-spot included: non-white race/ethnicity (aOR=3.04; CI=1.26-7.32), binge drinking (aOR=2.31; CI=1.04-5.11), and unprotected receptive anal sex with a male-born partner at last sexual encounter (aOR= 4.30; CI=1.19-15.49).

CONCLUSION: Findings suggest that transgender people of color and those engaging in recent HIV risk behavior have a higher probability of residing in Massachusetts cities with the highest HIV/AIDS prevalence. Future research should explore the sexual networks and behavioral norms of transgender residents of hot-spot cities so that targeted HIV prevention programs may be developed.