Research Into Substance Abuse and HIV Among Transgender Individuals

The little research that has been done on the prevalence of substance abuse in the transgender community suggests significantly high substance abuse rates. Some of the best information available comes from studies of HIV prevalence.

Substance use also plays a significant role in the high HIV prevalence in MTF transgender individuals (transgender women) (Longshore, Annon & Anglin, 1998; National Institute on Drug Abuse, 1994; Longshore et al., 1993). There are more than 15 studies that concluded that transgender individuals (primarily MTF transgender sex workers) have a high rate of HIV infection.

The most recent study on HIV prevalence in transgender individuals conducted by the San Francisco Department of Public Health AIDS Office (Clements et al., 1998) investigated more than 515 individuals with transgender experiences, which included MTF (sex workers and nonsex workers) and FTM transgender individuals (transgender men). The studyshowed that

• 35 percent of the MTF transgender individuals in the study tested HIV positive

• 63 percent of the African-American MTF transgender individuals in the study tested HIV positive

• 1.6 percent of the FTM transgender individuals in the study tested HIV positive. Although the FTM individuals studied had a low HIV prevalence rate, they commonly reported engaging in many of the same HIV risk behaviors as the MTF individuals.

The same study is one of the best available on substance abuse among transgender individuals. It showed a lifetime rate of intravenous drug use of

• 34 percent among MTF transgender individuals

• 18 percent among FTM transgender individuals.

Longshore and Hsieh (1998) found that substance use treatment does influence people’s HIV risk behavior. Treatment can help reduce transgender individuals’ risk of HIV infection if they remain in treatment; however, discrimination and prejudice against transgender individuals can make access to service agencies and health care resources problematic (Transgender Protocol Team, 1995; San Francisco Department of Public Health, AIDS Office, 1997; Bockting, Robinson & Rosser, 1998; Moriarty, Thiagalingam & Hill, 1998).

A study from Hollywood, California, reported that the drugs most commonly used by MTF transgender individuals were alcohol, cocaine/crack, and methamphetamine (Reback & Lombardi, 1999). In the Clements and colleagues (1998) study conducted in San Francisco, 55 percent of the MTF individuals reported they had been in alcohol or drug treatment sometime during their lifetimes.

In addition, violence and discrimination have been found to have negative effects upon gay, lesbian, and bisexual youth, encouraging substance abuse, prostitution, and suicide (Savin-Williams, 1994; Kreiss & Patterson, 1997; Rodgers, 1995). Garnets, Herek, and Levy (1992) stated that experiences of violence and harassment can significantly affect the mental health of gay men and lesbians, which in turn could influence their substance use as well as their experience in treatment. Experiences of violence and harassment could similarly affect transgender individuals. Transgender individuals are likely to experience some form of discrimination, harassment, and/or violence sometime in their lives. The first major study (Lombardi et al., submitted for publication) on violence and discrimination against transgender people in the United States found that:

• 60 percent experienced some form of harassment and/or violence sometime during their lives

• 37 percent experienced some form of economic discrimination.