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Related Needs, and Lifecourse Experiences of Transgender Virginians

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Related Needs, and Lifecourse Experiences of Transgender Virginians TTHEHE HHEALTH,EALTH, HHEALTHEALTH-- RRELATEDELATED NNEEDS,EEDS, ANDAND LLIFECOURSEIFECOURSE EEXPERIENCESXPERIENCES OFOF TTRANSGENDERRANSGENDER VVIRGINIANSIRGINIANS Prepared by: Jessica Xavier, M.P.H. Julie A. Honnold, Ph.D. Judith Bradford, Ph.D. Community Health Research Initiative Center for Public Policy Virginia Commonwealth University For: Virginia HIV Community Planning Committee and Virginia Department of Health January 2007 Virginia Transgender Health Initiative Study Statewide Survey Report Members of the Study Team: Judith Bradford, Ph.D. Principal Investigator and Project Director Jessica Xavier, M.P.H. Co-Investigator and Field Manager Michael Hendricks, Ph.D. Co-Investigator Mary Ellen Rives, M.P.A. Project Manager Julie A. Honnold, Ph.D. Statistical Analyst With the assistance of the Virginia Transgender Task Force, especially Martha Lees, Catherine Hulbert and Zakia Jemayece; Elaine Martin, Ted Heck, and Ami Gandhi of the Virginia Department of Health; and Edward Strickler of the Virginia HIV Community Planning Committee. Survey Distributors: Judith Bradford, Jessica Xavier, Ted Heck, Martha Lees, Madge Young, Bill Briggs, Magno Caballero, Tomas Cabrero, Ruby Corado, Earline Budd, Gray Border, Jane Whitaker, Martha Harris, E. Russell Lynn, Zakia Jemayece, Robert Key, Lauretta Safford, Christina Carter, Vega Perry, Irma Hinkle, Michael McIntyre, Pam Meador, Sara Sherrard, K’ai Smith, and Dr. Christopher Zitnay. Prepared under the auspices of the Virginia Department of Health, Division of Disease Prevention through the Centers for Disease Control and Prevention, Cooperative Agreement #: U62/CCU323468-01. Table of Contents Volume 1 List of Tables and Figures................................................................................................................................2 Executive Summary ..........................................................................................................................................3 Introduction .......................................................................................................................................................7 The Virginia Transgender Health Initiative Study......................................................................................8 Study Design and Methodology.....................................................................................................................9 Study Results................................................................................................................................................... 11 Standard Demographics........................................................................................................................... 11 Transgender-specific Demographics..................................................................................................... 15 Access to Regular Medical Care............................................................................................................ 16 Access to Transgender-related Health Care (including Mental Health)....................................... 18 Employment and Housing Discrimination ........................................................................................... 20 Sexual and Physical Violence................................................................................................................... 21 Suicidal Ideation and Attempts............................................................................................................... 22 Substance Use and Abuse ....................................................................................................................... 23 Knowledge of HIV/AIDS and Perception of Risk............................................................................... 25 Sexual Behaviors and Risks ..................................................................................................................... 26 Access to HIV/AIDS Prevention and Education Services................................................................. 28 HIV Testing and Status............................................................................................................................. 30 Access to HIV/AIDS Treatment Services ............................................................................................ 30 Regional Analysis…..…………………………………………………………………………..32 Summary of Findings……………………………………………………………………………..34 Limitations………………………………………………………………………………………..36 Recommendations to VDH and the VHCPC.......................................................................................... 38 References....................................................................................................................................................... 44 Appendix I: Glossary of Transgender Terminology............................................................................... 46 Appendix I1: Survey Questionnaire........................................................................................................... 48 Volume 2 Appendix III: Gender Vector Data Tables Appendix IV: Region Data Tables 1 List of Tables and Figures Figure 1: Conceptual Pathways Model…………………………..………………………..……10 Table 1: THIS Participant Standard Demographics ........................................................................... 13 Table 2: THIS Participant Transgender-Specific Demographics ..................................................... 16 Table 3: Access to Regular Medical Care............................................................................................ 17 Table 4: Mean Quality and Sensitivity Ratings for Access to Transgender Care........................ 19 Table 5: Employment and Housing Discrimination ........................................................................... 21 Table 6: Lifetime Drug Use..................................................................................................................... 24 Table 7: Current Drug Use..................................................................................................................... 24 Table 8: Sources of Information about HIV/AIDS ............................................................................. 25 Table 9: Knowledge of HIV/AIDS and Perception of Risk............................................................... 26 Table 10: Sexual Behaviors and Risks ..................................................................................................... 27 Table 11: Mean Quality and Sensitivity Ratings for Access to HIV Prevention and Education Services by All Participants ..................................................................................................... 29 Table 12: HIV Testing and Status............................................................................................................. 29 Table 13: Mean Quality and Sensitivity Ratings for Access to HIV Treatment Services by HIV+ Participants (n = 28, all MTFs)................................................................................................ 31 2 Executive Summary The Community Health Research Initiative (CHRI) of Virginia Commonwealth University conducted a statewide survey of transgender people living in Virginia as part of the Virginia Transgender Health Initiative Study (THIS). THIS, a multi-phase, multi-year project to improve the health of transgender Virginians, was implemented by CHRI under the direction of the Virginia Department of Health Division of Disease Prevention (VDH), advised by the Virginia HIV Community Planning Committee (VHCPC). The overall mission of the VHCPC, working with VDH under the guidance of the US Centers for Disease Control and Prevention, is to identify the most effective HIV prevention strategies for Virginia, including the development of a comprehensive plan and setting priorities for HIV/STD primary and secondary services in collaboration with consumers and providers. The quantitative component of THIS examines health care access by identifying the gaps in services needed by transgender people, in order to identify possible means to reduce risk behaviors in this population. Data were gathered on access to regular medical care, transgender-related medical care, HIV prevention and treatment services; HIV knowledge, risk behaviors, testing and status; employment and housing discrimination; sexual and physical violence, social support and self esteem; substance abuse and tobacco use; and suicidal ideation and attempts. Psychosocial variables unique to transgender people were also assessed to examine how they influenced HIV and other risks in this population. Recruitment of participants was conducted by CHRI staff, a Transgender Task Force, and VHCPC members, who promoted participation in the survey through service providers, transgender support groups, and informal peer networks. The questionnaire was available in three versions: a web-based version in English and paper versions in English and Spanish. The quantitative survey was conducted from September 2005 to July 2006 with 387 respondents and a final analysis sample of 350, including 229 MTFs (male-to-females) and 121 FTMs (female-to-males). With participants from 60 of the 136 cities and counties in Virginia, THIS is the first truly statewide needs assessment survey of a transgender population in the U.S. FTM participants were much younger than MTF participants, with median ages of 28 and 40 years, respectively. FTM participants were somewhat
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