Substance Abuse among High-Risk Transwomen in San Francisco and Alameda County

Background: Transwomen are at high risk for substance abuse due to exposure to transphobia and a lack of access to transgender sensitive care and support services.

Methods: The 5-year Mariposa Project aims to reduce substance use and HIV risk behaviors for transwomen of color in San Francisco and Alameda County. A total of 213 transwomen were recruited in the project and administered a structured questionnaire asking about substance use behaviors and psychosocial factors at baseline.

Results: High prevalence of substance use in the past 3 month was found: alcohol (74%), marijuana (66%), methamphetamines (35%), crack (18%), cocaine (19%), and depressants (17%).  High frequencies of substance use (more than once a day) were also found for marijuana (44%), methamphetamines (27%), and depressants (41%). Overall, 17.4% had been using hard drugs at least once a day (heavy drug use).  Heavy drug use was significantly associated with having commercial sex partners (p<0.01) and higher levels of transphobia (p<0.05).  Interestingly 82% of heavy drug users reported seeing a medical provider in the past 3 months as compared with 88% for non-heavy drug users.

Conclusion: Although the number is small, frequent use of hard drugs is troublesome. Results indicate that heavy drug users access medical care at roughly the same rate as non-heavy drug users. This suggests medical providers could be a key to substance abuse interventions.  Interventions that aim to reduce hard drug use among transwomen need to address psychosocial issues, such as sex work and transphobia.