25/07: Journal club -- Conceptualizing trans populations in research and implications in HIV prevention
Category: Journal Club
Posted by: Emilia
Lifetime Risk Factors for HIV/Sexually Transmitted Infections Among Male-to-Female Transgender Persons.
Nuttbrock L, Hwahng S, Bockting W, Rosenblum A, Mason M, Macri M, Becker J.
J Acquir Immune Defic Syndr. 2009 Jun 22. [Epub ahead of print]
PMID: 19550351 [PubMed - as supplied by publisher]
Sex Workers, Fem Queens, and Cross-Dressers: Differential Marginalizations and HIV Vulnerabilities Among Three Ethnocultural Male-to-Female Transgender Communities in New York City.
Hwahng SJ, Nuttbrock L.
Sex Res Social Policy. 2007 Dec;4(4):36-59.
PMID: 19079558 [PubMed]
The Nuttbrock, et al article, while brief, has an interesting finding. That the degree of one’s “social expression of transgender identity” was associated with HIV in a sample of transwomen of color. That is, the more people know about a person being trans and the more one interacts in public in female attire (their definition) the greater the likelihood of being HIV positive ( as well as for hepatitis B and C). This is somewhat similar to the finding made by Boles and Elifson in 1994 (PMID: 8066491) that “Transvestites from the high prevalence area are strongly committed to transvestism” ignoring the use of transvestite the findings of both studies indicate a difference within transgender feminine samples. Individuals who have a fulltime feminine gender presentation will experience greater problems than those with limited exposure. What this comes down to is the difference between groups that can be classified as crossdressers versus those who can be classified as transsexual (This is my classification and not related to the variation in identities and lives found among trans feminine individuals, but I do so now for ease of writing).
This is why I also want to include Hwahng and Nuttbrock’s 2007 article (from the same project) where they identify and describe three groups of trans feminine individuals involved in sex work. To sum them up, white crossdressers involved in sex work do so from a more privileged position compared to Asian sex workers, who are then better off compared to those from the House Ball Community. Hwahng and Nuttbrock’s summary is that white crossdressers benefit from their race privilege and from the fact that they are still embedded within masculine social and employment contexts. There is also the issue of social presentation in that the crossdresser group are not as focused on body-modifications as those in the House Ball and Asian Sex Worker groups. In the end, the crossdresser group are not at risk for HIV compared to the other two groups. Nuttbrock’s recent article supports this as well. In that study HIV was found among 3.5% of the White participants compared to 49.6% and 48.1% of the Hispanic and African-American participants. White participants also reported fewer years of injecting female hormones, less sexual interest in men, less identity disclosure, and less presenting in public as female compared to the transwomen of color. The finding that transwomen of color have high rates of HIV infection mirrors many other studies of transwomen and HIV. Although, other studies (like San Francisco) still reported rates of HIV infection among their White participants as being greater then what Nuttbrock found in his sample. I think that this is a sampling and conceptualization issue that needs to be discussed.
Studies examining transwomen tend to group together a wide range of identities and behaviors. While these identities are many times dependent upon one’s own socio-cultural context and viewpoints, what is more crucial is the issue of public exposure (described in Nuttbrock, et al). Men who crossdress, for the most part, do not have the same social exposure as those who are male bodied, but identify as women and seek to have a fulltime feminine social role (using transsexual to refer to these people for now). Men who crossdress do not have the same problems as transsexual women. Crossdressers are able to retain a level of privilege and social benefits than those transitioning from one gender to another. Crossdresser gender performances tend to be more restricted in social space and time than that of transsexual women. Greater social exposure as transwomen is associated with greater problems. Nuttbrock found this in regards to HIV infection, while I found a similar thing in a recent paper myself (Lombardi, E. Varieties of Transgender/Transsexual Lives and their Relationship with Transphobia. Journal of Homosexuality. In Press.). When conceptualizing transpopulations at risk for HIV we must focus on those with greater exposure, that is, those with fulltime social presentation rather than those who only dress on occasions.
There are already interventions designed for transpeople, much do seem to be oriented toward those who have a fulltime (or close to fulltime) social presentation. Crossdressers tend to not get the same level of resources, but based on Nuttbrock’s study, they may not need it. In addition, would inclusion of crossdressers into an intervention like TWISTA (an adaptation of SISTA for transwomen of color) be beneficial to them or the other participants. People have been voicing the need to conceptualize transwomen as distinct from MSM within the HIV field (and rightly so), but I don’t think that crossdressers should be. Interventions targeting MSM categories could be adapted for white men who crossdress and have sex with men. But in light of the current economic crisis and the lack of research noting a clear risk for HIV, I don’t think that will happen anytime soon.
Nuttbrock L, Hwahng S, Bockting W, Rosenblum A, Mason M, Macri M, Becker J.
J Acquir Immune Defic Syndr. 2009 Jun 22. [Epub ahead of print]
PMID: 19550351 [PubMed - as supplied by publisher]
Sex Workers, Fem Queens, and Cross-Dressers: Differential Marginalizations and HIV Vulnerabilities Among Three Ethnocultural Male-to-Female Transgender Communities in New York City.
Hwahng SJ, Nuttbrock L.
Sex Res Social Policy. 2007 Dec;4(4):36-59.
PMID: 19079558 [PubMed]
The Nuttbrock, et al article, while brief, has an interesting finding. That the degree of one’s “social expression of transgender identity” was associated with HIV in a sample of transwomen of color. That is, the more people know about a person being trans and the more one interacts in public in female attire (their definition) the greater the likelihood of being HIV positive ( as well as for hepatitis B and C). This is somewhat similar to the finding made by Boles and Elifson in 1994 (PMID: 8066491) that “Transvestites from the high prevalence area are strongly committed to transvestism” ignoring the use of transvestite the findings of both studies indicate a difference within transgender feminine samples. Individuals who have a fulltime feminine gender presentation will experience greater problems than those with limited exposure. What this comes down to is the difference between groups that can be classified as crossdressers versus those who can be classified as transsexual (This is my classification and not related to the variation in identities and lives found among trans feminine individuals, but I do so now for ease of writing).
This is why I also want to include Hwahng and Nuttbrock’s 2007 article (from the same project) where they identify and describe three groups of trans feminine individuals involved in sex work. To sum them up, white crossdressers involved in sex work do so from a more privileged position compared to Asian sex workers, who are then better off compared to those from the House Ball Community. Hwahng and Nuttbrock’s summary is that white crossdressers benefit from their race privilege and from the fact that they are still embedded within masculine social and employment contexts. There is also the issue of social presentation in that the crossdresser group are not as focused on body-modifications as those in the House Ball and Asian Sex Worker groups. In the end, the crossdresser group are not at risk for HIV compared to the other two groups. Nuttbrock’s recent article supports this as well. In that study HIV was found among 3.5% of the White participants compared to 49.6% and 48.1% of the Hispanic and African-American participants. White participants also reported fewer years of injecting female hormones, less sexual interest in men, less identity disclosure, and less presenting in public as female compared to the transwomen of color. The finding that transwomen of color have high rates of HIV infection mirrors many other studies of transwomen and HIV. Although, other studies (like San Francisco) still reported rates of HIV infection among their White participants as being greater then what Nuttbrock found in his sample. I think that this is a sampling and conceptualization issue that needs to be discussed.
Studies examining transwomen tend to group together a wide range of identities and behaviors. While these identities are many times dependent upon one’s own socio-cultural context and viewpoints, what is more crucial is the issue of public exposure (described in Nuttbrock, et al). Men who crossdress, for the most part, do not have the same social exposure as those who are male bodied, but identify as women and seek to have a fulltime feminine social role (using transsexual to refer to these people for now). Men who crossdress do not have the same problems as transsexual women. Crossdressers are able to retain a level of privilege and social benefits than those transitioning from one gender to another. Crossdresser gender performances tend to be more restricted in social space and time than that of transsexual women. Greater social exposure as transwomen is associated with greater problems. Nuttbrock found this in regards to HIV infection, while I found a similar thing in a recent paper myself (Lombardi, E. Varieties of Transgender/Transsexual Lives and their Relationship with Transphobia. Journal of Homosexuality. In Press.). When conceptualizing transpopulations at risk for HIV we must focus on those with greater exposure, that is, those with fulltime social presentation rather than those who only dress on occasions.
There are already interventions designed for transpeople, much do seem to be oriented toward those who have a fulltime (or close to fulltime) social presentation. Crossdressers tend to not get the same level of resources, but based on Nuttbrock’s study, they may not need it. In addition, would inclusion of crossdressers into an intervention like TWISTA (an adaptation of SISTA for transwomen of color) be beneficial to them or the other participants. People have been voicing the need to conceptualize transwomen as distinct from MSM within the HIV field (and rightly so), but I don’t think that crossdressers should be. Interventions targeting MSM categories could be adapted for white men who crossdress and have sex with men. But in light of the current economic crisis and the lack of research noting a clear risk for HIV, I don’t think that will happen anytime soon.
