Psychosocial factors contributing to a syndemic of substance use and HIV risk among Floridian transgender women

Psychosocial factors contributing to a syndemic of substance use and HIV risk among Floridian transgender women | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Psychosocial factors contributing to a syndemic of substance use and HIV risk among Floridian transgender women View ORCID Profile Daniell Sullivan , View ORCID Profile Rachel Clarke , Hannah Wilson , View ORCID Profile Jessy Dévieux , View ORCID Profile Elena Cyrus doi: https://doi.org/10.1101/2024.10.04.24314900 Daniell Sullivan 1 University of Central Florida, College of Medicine , Orlando, FL, USA BS Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Daniell Sullivan For correspondence: da789405{at}ucf.edu Rachel Clarke 2 Florida International University, College of Medicine , Miami, FL, USA PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Rachel Clarke Hannah Wilson 1 University of Central Florida, College of Medicine , Orlando, FL, USA BS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jessy Dévieux 3 Florida International University, Robert Stempel College of Public Health & Social Work , Miami, FL, USA PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Jessy Dévieux Elena Cyrus 1 University of Central Florida, College of Medicine , Orlando, FL, USA PhD, MPH Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Elena Cyrus Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background Transgender women are at heightened risk of HIV and substance misuse due to systemic discrimination and structural healthcare barriers at the macro, meso, and micro levels. Floridian Transgender Women (FTW) face unique challenges in an environment with limited resources and inconsistent epidemiological data. Syndemic theory, which examines how co-occurring conditions like HIV and substance use disorders (SUD) are driven by large-scale factors, has not been fully explored in FTW. Objective This study aimed to identify psychosocial factors contributing to substance use and HIV risk from a syndemic perspective among FTW. Methods From May 2021 to November 2023, over 500 at-risk FTW were recruited from community partner agencies in Miami-Dade and Orlando counties for a larger prospective study. Univariate analysis identified psychosocial factors, while bivariate analysis explored their contributions to the syndemic of substance misuse and HIV risk. Results Out of 160 participants screened, 55.6% were ineligible, leaving 89 enrolled. Participants ranged in age from 18 to 63, with 25% identifying as people of color. Mental illness was reported by 62.9%, with depression and anxiety being the most common diagnoses. However, only 29.2% had accessed mental health care in the past year. Despite high rates of substance use—48.8% reported drug use during sex, 46.1% likely had an SUD, and 25.8% reported hazardous drinking—68.9% perceived their quality of life as high. Drug use during sex was significantly associated with intimate partner violence (IPV) (p=.01) and perceived quality of life (p=.003). Conclusion FTW face significant challenges, including discrimination, mental illness, trauma, and IPV, which increase the risk of substance use, particularly marijuana and alcohol. Despite these challenges, many maintain a high perceived quality of life. The syndemic interaction calls for comprehensive interventions addressing financial, mental health, and accessibility barriers. Further research into socio-political stressors that exacerbate substance use and high-risk behaviors is recommended. Background Nationally, transgender women are disproportionately susceptible to HIV due to significant healthcare barriers, with an estimated prevalence of 14.1% in some surveillance groups compared to their cisgender counterparts’ 0.5%. 1 Additionally, this population also engages in higher rates of illicit substance use, attributed to various psychosocial factors such as housing instability, mental illness, and socioeconomic status. Substance use in transgender women is known to drive high risk sexual behaviors (HRSBs) and thereby HIV infection risk. 2 , 3 , 4 , 5 In other words, this community exhibits an HIV and substance use syndemic, a phenomenon where societal circumstances affect how two or more health conditions interact within a population. 6 Importantly, Florida (FL) has the second largest population of trans adults in the United States, mostly concentrated in Orlando and Miami, so the proportion of Floridian transgender women (FTW) is somewhat reflective of the national community. 7 , 8 Limited substance use and HIV epidemiological data exists for FTW. In fact, to our knowledge, there are no consistent estimates for FTW HIV prevalence. This is a harrowing realization since FL leads the nation in new HIV cases. 9 Previously, we estimated the FTW HIV prevalence to be around 38.6%, nearly triple the national transgender women prevalence and 64 times greater than the prevalence of Florida’s general population. 9 , 10 , 11 , 12 Moreover, FL has the highest rate of new HIV cases in the nation, partially caused by a universal lack of access to care. 9 , 13 Therefore, we sought to identify certain psychosocial factors that syndemically influence this disproportionality in HIV prevalence and illicit substance use rates utilizing Bronfrenbrenner’s ecological systems theory. At the foundational level, this theory examines how bioecological interactions on varying scales influence an individual’s development. These scales include microsystems, consisting of direct interpersonal relationships; mesosystems comprised of multiple microsystems; macrosystems, such as socioeconomic status and cultural ideologies. 14 When applied to populations, the theory appropriately conveys the interconnectedness of psychosocial factors that contribute to a syndemic. For example, one study employed this approach to identify psychosocial factors that synergistically influence HIV risk in black transgender women and men who have sex with men. 15 However, no study to our knowledge has applied this framework to FTW specifically. Because of the regional sociopolitical climate, FTW are understudied and research directed towards this population is underfunded. Therefore, FTW are especially vulnerable compared to their national counterparts, considering FL has enacted six anti-LGBTQ laws in the past year, significantly limiting FTW’s access to treatment. 16 Moreover, state legislation that restricts TW’s access to gender-affirming care may promote medical mistrust that prevents TW from seeking care elsewhere, further contributing to the high HIV prevalence in this population. 16 For the above reasons, the present study focused on this specific geographic population. The main objective of this study was to identify and explore associations between psychosocial factors that contribute to illicit substance use and HIV infection risk from a syndemic perspective in FTW. Methods Participants FTW were recruited throughout central and southern Florida between May 2021 to November 2023 as part of a longitudinal parent study termed To Reach Unrestricted Services for Transwomen (TRUST) (PI: Dr. Elena Cyrus). Recruitment involved partnering with Florida federally qualified healthcare centers (FQHC) in the Orlando and Miami areas serving transgender women,, as well as social media outreach. The Miami centers included “Sunserve” and “Arianna’s Center,” in Miami-Dade County and “26 Health” in the Orlando area. Individuals who were assigned male sex at birth and currently identify as adult (≥18years) female were enrolled in the study. Participant HIV serostatus was collected via self-report and laboratory confirmatory testing. Those <18 years old or HIV positive were excluded from the study. Out of 160 participants screened, 90 met study criteria and completed the baseline questionnaire at the time of analysis. At baseline, each participant completed an interviewer-administered questionnaire using Research Electronic Data Capture (REDCap) and included information related to participant demographics and behaviors. 17 , 18 REDCap is a secure, web-based software platform designed to support data capture for research studies, providing 1) an intuitive interface for validated data capture; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for data integration and interoperability with external sources. Ethics Statement Because this was secondary analysis of an existing dataset, this research project received IRB exemption from the UCF IRB, as all data used for the study and subsequent analyses had already been de-identified, and the original study was previously approved for conduct of human subjects research by same IRB Variables Demographics Participants provided information related to race, ethnicity, sexual orientation, monthly income, and age. HIV Infection Risk HRSBs are highly predictive of HIV infection risk 19 and were therefore used as a proxy variable for measurable HIV infection risk. HRSBs included unprotected sex, or engaging in condomless penetrative/receptive anal sex within the last 6 months; multiple sex partners, or having ≥2 sex partners in the past 6 months; drug use during sex, or using drugs immediately before or during a sexual encounter in the last 6 months; and alcohol use during sex, or using alcohol immediately before or during a sexual encounter in the last 6 months. Substance Use Participant substance use data included substance type and frequency, ranging from daily to one time in the last 6 months. Substance types were then classified according to the following Drug Recognition Expert categories: cannabinoids included marijuana and synthetic cannabis, hallucinogens included LSD and MDMA, inhalants included amyl nitrite (i.e. poppers), stimulants included cocaine and methamphetamine, depressants included benzodiazepines and GHB, narcotic analgesics included opioids, and dissociative anesthetics included ketamine. 20 Hazardous drinking was defined by having an Alcohol Use Disorder Identification Test (AUDIT) score ≥8, which correlates to a higher likelihood of having an alcohol use disorder and consequently requires further intervention. 21 Substance use disorders (SUD) likely were defined as having a Drug Abuse Screening Test – 10 (DAST-10) 22 score of ≥3, which has a high likelihood of meeting DSM criteria for an SUD. 23 Psychosocial Factors Discrimination was defined as having a prior subjective experience of physical or verbal discrimination based on gender identity/presentation, race, ethnicity, or skin color. Trauma was defined as having history of experiencing at least one traumatic event during this lifetime. Intimate partner violence (IPV) was defined as having a history of experiencing sexual or physical violence at the hands of a partner. Mental health history referred to ever having a history of receiving a mental illness diagnosis (yes or no). If yes, current mental illness was subclassified based on diagnosis, including depression, anxiety, and PTSD. Mental health care discrimination was defined as having experienced problems seeking mental health care due to gender presentation. Participants were also asked on whether or not they accessed mental health care resources in the past 12 months. Homelessness was defined as living without housing at any point in time. Incarceration was defined as being imprisoned at any point in time. Perceived quality of life (pQoL) was measured on a categorical scale from 0-4, where 0 indicated very poor quality of life and 4 reflected a very high quality of life. Those who answered 0-1 were categorized as having a poor pQoL. Those who answered 2, which equated to neither poor nor high quality of life, were categorized as having an average pQoL. Participants who answered 3-4 were categorized as having a high pQoL. Data Analysis Income and age were open ended and continuous. Nominal categorical variables included current mental illness, substance type, and race. pQoL was categorized as the only ordinal variable as previously described. All other variables were binary. Univariate and bivariate frequencies were conducted to describe the study population, psychosocial factors, and risk behaviors. Variable frequencies are reported based on the valid percentage of responders. Chi Square tests were conducted to examine associations between psychosocial factors and HRSBs and substance yse, where associations were considered significant at alpha = 0.05. Statistical Package for the Social Sciences (SPSS) version 28 software was utilized to conduct all analyses. Results Descriptive Results Participant demographic characteristics are presented in Table 1 . The mean age was 28.4 years (standard deviation = 8.8, range = 18.0-63.42). Within our sample, 38.6% of participants identified as Hispanic. Overall, 54.5% of participants identified as White, 13.6% as African American, 2.3% as Asian, and 13.6% as Multiracial. Reported sexual orientation was broad, but the majority of participants identified as either pansexual or queer (36.3% total). On average, participants only had a monthly income of $1785.90 (standard deviation = $1634.7, range = $0-8000). View this table: View inline View popup Download powerpoint Table 1. Participant demographics for the TRUST Study (n=89). Psychosocial factors are show in Table 2 . The majority of particpants reported experiencing discrimination, trauma, and mental illness at one point in their lifetime at 88.8%, 87.6%, and 62.9%, respectively; yet, 69.3% of these women reported having a high pQoL. Of those previously diagnosed with a mental health condition, the majority experienced comorbid illness, particularly anxiety and depression as shown in Table 3 . View this table: View inline View popup Download powerpoint Table 2. Cross-Sectional self-reported psychosocial factors for the TRUST Study at the Baseline Visit (n=89). View this table: View inline View popup Download powerpoint Table 3. Participants’ current mental health status among TRUST baseline participants who reported ever having a mental health diagosis (n=56). Table 4 shows the rates of HRSBs, as 42.0% had multiple sex partners in the last 6 months, and nearly 18.2% engaged in unprotected sex. 35.2% used alcohol before sex, and 26.1% were considered to engage in hazardous levels of drinking. 45.5% report using drugs during sex, and 46.6% were considered to likely have an SUD. View this table: View inline View popup Download powerpoint Table 4. Self-reported high risk sexual behaviors among TRUST Baseline partipants who were sexually active Study (n=84). Table 5 shows the percentage of participant substance use classified into individual substances. Participants were most likely to use cannabinoids with 73.0% participants using over the last 6 months. 51.1% of participants reported using marijuana over the last month and 100% of responders reported using at least once in the past 6 months, as the remaining 27% did not provide input to their marijuana use behaviors. The next most used drugs over the past 6 months were hallucinogens at 36.4%, inhalants at 21.6%, and stimulants at 14.8%. View this table: View inline View popup Download powerpoint Table 5. Participant substance use in the past 6 months reported by baseline TRUST participants (n=89). Analytic Results When examining the relationships between psychosocial factors with HRSBs and substance use, chi squared analyses revealed a significant association between drug use during sex and IPV (p=.017) as well as pQoL and Drug use during sex (p = 0.003). All other associations between SPFs and HRSBs were nonsignificant. Secondary analysis between HRSBs revealed a significant correlation between alcohol use during sex and drug use during sex (p<.001). Discussion We investigated the influence of various psychosocial factors on the syndemic of HIV and substance use disorder (SUD) among Floridian transwomen. Our analyses reveal multiple syndemics between psychosocial factors and high-risk sexual behaviors (HRSBs), as well as within these categories themselves. Participants experienced disproportionately high rates of lifetime homelessness, more than double the national average. 24 Additionally, 62.9% of participants had been diagnosed with a mental health condition, a significant increase compared to the 22.8% national average for adults diagnosed with mental illness in the past year. 25 This high prevalence may be explained by the almost universal reporting of trauma and discrimination. Comorbid depression and anxiety were the most commonly reported conditions, with 44.9% of participants diagnosed with depression—slightly higher than the estimated 31% in the national transgender population, potentially influenced by state-specific anti-transgender legislation. 26 Despite elevated rates of mental illness, only 29.2% of participants had accessed mental health care in the past year, representing about one-third of those with a diagnosed condition. This figure contrasts with the 59.8% of the general population who accessed mental health care in 2023, highlighting significant barriers for transwomen, such as medical mistrust, a lack of mental health providers, and limited socioeconomic resources. 25 Substance use was also notably high in this cohort. One in four participants reported hazardous drinking, as indicated by their AUDIT scores—higher than the 18% rate reported among transgender individuals nationally. 27 This suggests that Floridian transwomen may be at even greater risk for alcohol use disorders (AUDs) than their peers in other states. All participants who responded about illicit substance use had used marijuana at least once in the past six months, and over 50% used it at least monthly—nearly triple the national average for individuals aged 12 and older. 25 For comparison, past three-month cannabis use among U.S. transgender individuals was previously reported at 24.4%, further suggesting a potential geographic influence. 28 Additionally, participants exhibited significantly higher use rates of other illicit substances, particularly hallucinogens, cocaine, and MDMA. Nearly half (46.1%) of participants were likely to have a substance use disorder (SUD), more than double the rate seen in the general population. 25 This widespread recreational drug use correlates with the 48.8% of participants who reported drug use during sex, a known HRSB and predictor of HIV risk. Interestingly, higher rates of intimate partner violence (IPV) were associated with drug use during sex. This may reflect a coping mechanism related to transactional sex or pervasive violence experienced by the population. Transwomen are already at an increased risk for IPV, and those with lower socioeconomic status—evidenced by a median income of just under $1,800—are especially vulnerable. 29 Partner abuse, particularly when sexual in nature, can trigger a trauma response in subsequent sexual activities, potentially leading to self-medication to suppress this response. 30 Further analysis revealed a significant association between two HRSBs: drug use during sex and alcohol use during sex, a relationship well-established in existing literature. Concurrent substance use may synergistically increase Floridian transwomen’s HIV infection risk compared to the use of a single substance. 31 These within-group associations between psychosocial factors and HRSBs exemplify the classic characteristics of a syndemic: specific psychosocial variables have a combinatorial effect on behaviors, health outcomes, and subsequent HIV risk. In other words, the factors driving the HIV disease burden are additive, not independent. 6 Low income and high levels of discrimination—both seen in this study—likely prevent transgender women from accessing health care and resources, contributing to high HIV prevalence. 32 Additionally, a lack of educational resources tailored to this specific community further lowers HIV risk perception and increases transmission rates. 33 Despite facing disproportionately high levels of trauma, IPV, discrimination, mental illness, and financial adversity compared to cisgender individuals, Floridian transwomen report a surprisingly high perceived quality of life (pQoL), showcasing the resilience of this community. 7 , 34 , 35 The relationship between high pQoL and drug use during sex observed in this study may be bidirectional. Some transwomen may use drugs as a coping mechanism that temporarily enhances their perceived QoL, while also impairing their awareness of the consequences of HRSBs. 10 On the other hand, many transwomen engage in sex work for financial stability, where they are more likely to be exposed to and coerced into drug use.. 36 Several limitations of this study should be noted. The sample size was underpowered, as the parent study was exploratory in nature, meaning only associations could be analyzed. Although most participants provided data for each variable, response rates varied between questions, reducing the study’s power. Notably, 74% of participants did not respond to questions about condom use, likely due to social desirability bias—the tendency to underreport socially undesirable behaviors such as sexual practices, drug use, and mental health conditions, while overreporting more acceptable behaviors. 37 Moreover, the majority of participants identified as white, limiting the generalizability of these findings. Black transwomen were particularly underrepresented, possibly due to the chain referral recruitment method used in this study. A larger and more diverse sample size may yield more significant associations between psychosocial factors and HRSBs. In the future, Northern Floridian transwomen should also be included in the sample to ensure the results are representative statewide. As the parent study (ENTRUST) progresses, participants’ HIV status will be reassessed to determine how these psychosocial factors and behaviors contribute to HIV infection risk. Data from those who become HIV-positive can be used to create predictive models for HIV risk in transgender women based on these factors and behaviors. Ultimately, targeted interventions addressing psychosocial factors—particularly violence and financial insecurity—can help reduce substance use rates and the HRSBs that drive HIV infection risk. Data Availability All data produced in the present study are available upon reasonable request to the authors. Footnotes The word "factors" has been added to the title. References 1. ↵ Center for Disease Control and Prevention. HIV and transgender people fact sheet. Updated May 31, 2022 . Accessed August 23, 2023 , 2. ↵ Lowry R , Holtzman D , Truman BI , Kann L , Collins JL , Kolbe LJ . Substance use and HIV-related sexual behaviors among US high school students: are they related? Am J Public Health . Jul 1994 ; 84 ( 7 ): 1116 – 20 . doi: 10.2105/ajph.84.7.1116 OpenUrl CrossRef PubMed Web of Science 3. ↵ Fredriksen Goldsen KI , Romanelli M , Hoy-Ellis CP , Jung H. Health, economic and social disparities among transgender women, transgender men and transgender nonbinary adults: Results from a population-based study . Prev Med . Mar 2022 ; 156 : 106988 . doi: 10.1016/j.ypmed.2022.106988 OpenUrl CrossRef PubMed 4. ↵ Falck F , Bränström R. The significance of structural stigma towards transgender people in health care encounters across Europe: Health care access, gender identity disclosure, and discrimination in health care as a function of national legislation and public attitudes . BMC Public Health. 2023/05/31 2023 ; 23 ( 1 ): 1031 . doi: 10.1186/s12889-023-15856-9 OpenUrl CrossRef 5. ↵ Cotaina M , Peraire M , Boscá M , Echeverria I , Benito A , Haro G. Substance Use in the Transgender Population: A Meta-Analysis . Brain Sci . Mar 10 2022 ; 12 ( 3 ) doi: 10.3390/brainsci12030366 OpenUrl CrossRef 6. ↵ Rudd KE , Mair CF , Angus DC . Applying Syndemic Theory to Acute Illness . Jama . Jan 4 2022 ; 327 ( 1 ): 33 – 34 . doi: 10.1001/jama.2021.22583 OpenUrl CrossRef 7. ↵ Cyrus E , Johnson SA , Perez-Gilbe HR , et al. Engagement in Care and Housing Instability Influence HIV Screening Among Transgender Individuals in South Florida . Transgend Health . Feb 2022 ; 7 ( 1 ): 52 – 60 . doi: 10.1089/trgh.2020.0066 OpenUrl CrossRef 8. ↵ Gov . DeSantis Signs Slate of Extreme Anti-LGBTQ+ Bills, Enacting a Record-Shattering Number of Discriminatory Measures Into Law. May 17, 2023 , Accessed August 23, 2023 . 9. ↵ Center for Disease Control and Prevention . HIV in the United States by Region: Knowledge of Status. HIV Statistics Center . Accessed January 31, 2023 , 10. ↵ Santos GM , Rapues J , Wilson EC , et al. Alcohol and substance use among transgender women in San Francisco: prevalence and association with human immunodeficiency virus infection . Drug Alcohol Rev . May 2014 ; 33 ( 3 ): 287 – 95 . doi: 10.1111/dar.12116 OpenUrl CrossRef 11. ↵ Sullivan D WH , Coudray M , Cyrus E. Psychosocial syndemic factors impacting sexual risk behavior and HIV prevalence among Floridian trans women. presented at: The Society for the Scientific Study of Sexuality 65th Annual Conference ; November 3, 2022 2022; Vancouver, BC, Canada . 12. ↵ Becasen JS , Denard CL , Mullins MM , Higa DH , Sipe TA . Estimating the Prevalence of HIV and Sexual Behaviors Among the US Transgender Population: A Systematic Review and Meta-Analysis, 2006–2017 . American Journal of Public Health . 2019 ; 109 ( 1 ): e1 – e8 . doi: 10.2105/ajph.2018.304727 OpenUrl CrossRef 13. ↵ Royal D. Experts Say Florida’s HIV Epidemic is Fueled By Stigma, Lack of Access to Care . Accessed January 31, 2023 , 14. ↵ Guy-Evans O. Bronfenbrenner’s Ecological Systems Theory. Updated 17 January 2024 . Accessed 5 August 2024, 2024 . 15. ↵ Teixeira da Silva D , Bouris A , Voisin D , Hotton A , Brewer R , Schneider J. Social Networks Moderate the Syndemic Effect of Psychosocial and Structural Factors on HIV Risk Among Young Black Transgender Women and Men who have Sex with Men . AIDS Behav. Jan 2020 ; 24 ( 1 ): 192 – 205 . doi: 10.1007/s10461-019-02575-9 OpenUrl CrossRef 16. ↵ Beaty T , Farrington B , Schoenbaum H. Transgender adults in Florida are blindsided that a new law also limits their access to health care . June 4, 2023 . Accessed August 23, 2023 . 17. ↵ Harris PA , Taylor R , Thielke R , Payne J , Gonzalez N , Conde JG . Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support . Journal of Biomedical Informatics. 2009/04/01/ 2009 ; 42 ( 2 ): 377 – 381 . doi: 10.1016/j.jbi.2008.08.010 OpenUrl CrossRef PubMed Web of Science 18. ↵ Harris PA , Taylor R , Minor BL , et al. The REDCap consortium: Building an international community of software platform partners . Journal of Biomedical Informatics. 2019/07/01/ 2019 ; 95 : 103208 . doi: 10.1016/j.jbi.2019.103208 OpenUrl CrossRef PubMed 19. ↵ (UNAIDS) JUNPoHA . Global report: UNAIDS report on the global AIDS epidemic 2013 . November 2023. 20. ↵ Drug Recognition Expert (DRE) Category and Schedule of Drugs ( 2018 ). 21. ↵ Babor T , Higgins-Biddle J , Saunders J , Monteiro M. The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care. Second ed. World Health Organization: Department of Mental Health and Substance Dependence ; 2001 . 22. ↵ Skinner HA . The drug abuse screening test . Addict Behav . 1982 ; 7 ( 4 ): 363 – 71 . doi: 10.1016/0306-4603(82)90005-3 OpenUrl CrossRef PubMed Web of Science 23. ↵ Skinner HA . Guide For Using the Drug Abuse Screening Test . 1982 . 24. ↵ National Academies of Sciences E, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Policy and Global Affairs; Science and Technology for Sustainability Program; Committee on an Evaluation of Permanent Supportive Housing Programs for Homeless Individuals. Appendix C , Counting the Number of Individuals Experiencing Homelessness . Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness . 2018 . 25. ↵ Substance Abuse and Mental Health Services Administration. Data from: National Survey on Drug Use and Health . 2022 -2023. 26. ↵ Wanta JW , Niforatos JD , Durbak E , Viguera A , Altinay M. Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study . Transgend Health . 2019 ; 4 ( 1 ): 313 – 315 . doi: 10.1089/trgh.2019.0029 OpenUrl CrossRef 27. ↵ Staples JM , Neilson EC , George WH , Flaherty BP , Davis KC . A descriptive analysis of alcohol behaviors across gender subgroups within a sample of transgender adults . Addict Behav . Jan 2018 ; 76 : 355 – 362 . doi: 10.1016/j.addbeh.2017.08.017 OpenUrl CrossRef 28. ↵ Gonzalez CA , Gallego JD , Bockting WO . Demographic Characteristics, Components of Sexuality and Gender, and Minority Stress and Their Associations to Excessive Alcohol, Cannabis, and Illicit (Noncannabis) Drug Use Among a Large Sample of Transgender People in the United States . J Prim Prev . Aug 2017 ; 38 ( 4 ): 419 – 445 . doi: 10.1007/s10935-017-0469-4 OpenUrl CrossRef 29. ↵ Bonomi AE , Trabert B , Anderson ML , Kernic MA , Holt VL . Intimate partner violence and neighborhood income: a longitudinal analysis . Violence Against Women . Jan 2014 ; 20 ( 1 ): 42 – 58 . doi: 10.1177/1077801213520580 OpenUrl CrossRef PubMed 30. ↵ El-Bassel N , Gilbert L , Wu E , Go H , Hill J. Relationship between drug abuse and intimate partner violence: a longitudinal study among women receiving methadone . Am J Public Health . Mar 2005 ; 95 ( 3 ): 465 – 70 . doi: 10.2105/ajph.2003.023200 OpenUrl CrossRef PubMed Web of Science 31. ↵ Herbst JH , Jacobs ED , Finlayson TJ , McKleroy VS , Neumann MS , Crepaz N. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review . AIDS Behav . Jan 2008 ; 12 ( 1 ): 1 – 17 . doi: 10.1007/s10461-007-9299-3 OpenUrl CrossRef PubMed Web of Science 32. ↵ Poteat T , Reisner SL , Radix A. HIV epidemics among transgender women . Curr Opin HIV AIDS . Mar 2014 ; 9 ( 2 ): 168 – 73 . doi: 10.1097/coh.0000000000000030 OpenUrl CrossRef PubMed 33. ↵ De Santis JP , Hauglum SD , Deleon DA , Provencio-Vasquez E , Rodriguez AE . HIV risk perception, HIV knowledge, and sexual risk behaviors among transgender women in South Florida . Public Health Nursing . 2017 ; 34 ( 3 ): 210 – 218 . doi: 10.1111/phn.12309 OpenUrl CrossRef 34. ↵ Valentine SE , Peitzmeier SM , King DS , et al. Disparities in Exposure to Intimate Partner Violence Among Transgender/Gender Nonconforming and Sexual Minority Primary Care Patients . LGBT Health . Aug 2017 ; 4 ( 4 ): 260 – 267 . doi: 10.1089/lgbt.2016.0113 OpenUrl CrossRef 35. ↵ Aparicio-García ME , Díaz-Ramiro EM , Rubio-Valdehita S , López-Núñez MI , García-Nieto I. Health and Well-Being of Cisgender, Transgender and Non-Binary Young People . Int J Environ Res Public Health . Sep 28 2018 ; 15 ( 10 ) doi: 10.3390/ijerph15102133 OpenUrl CrossRef 36. ↵ Budhwani H , Hearld KR , Butame SA , Naar S , Tapia L , Paulino-Ramírez R. Transgender Women in Dominican Republic: HIV, Stigma, Substances, and Sex Work . AIDS Patient Care STDS . Dec 2021 ; 35 ( 12 ): 488 – 494 . doi: 10.1089/apc.2021.0127 OpenUrl CrossRef 37. ↵ Latkin CA , Edwards C , Davey-Rothwell MA , Tobin KE . The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland . Addict Behav . Oct 2017 ; 73 : 133 – 136 . doi: 10.1016/j.addbeh.2017.05.005 OpenUrl CrossRef PubMed View the discussion thread. Back to top Previous Next Posted October 08, 2024. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Psychosocial factors contributing to a syndemic of substance use and HIV risk among Floridian transgender women Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Psychosocial factors contributing to a syndemic of substance use and HIV risk among Floridian transgender women Daniell Sullivan , Rachel Clarke , Hannah Wilson , Jessy Dévieux , Elena Cyrus medRxiv 2024.10.04.24314900; doi: https://doi.org/10.1101/2024.10.04.24314900 Share This Article: Copy Citation Tools Psychosocial factors contributing to a syndemic of substance use and HIV risk among Floridian transgender women Daniell Sullivan , Rachel Clarke , Hannah Wilson , Jessy Dévieux , Elena Cyrus medRxiv 2024.10.04.24314900; doi: https://doi.org/10.1101/2024.10.04.24314900 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Epidemiology Subject Areas All Articles Addiction Medicine (573) Allergy and Immunology (865) Anesthesia (302) Cardiovascular Medicine (4453) Dentistry and Oral Medicine (444) Dermatology (383) Emergency Medicine (609) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1515) Epidemiology (15242) Forensic Medicine (30) Gastroenterology (1131) Genetic and Genomic Medicine (6615) Geriatric Medicine (669) Health Economics (1001) Health Informatics (4552) Health Policy (1372) Health Systems and Quality Improvement (1614) Hematology (543) HIV/AIDS (1270) Infectious Diseases (except HIV/AIDS) (15929) Intensive Care and Critical Care Medicine (1106) Medical Education (624) Medical Ethics (147) Nephrology (670) Neurology (6625) Nursing (346) Nutrition (999) Obstetrics and Gynecology (1148) Occupational and Environmental Health (957) Oncology (3344) Ophthalmology (979) Orthopedics (369) Otolaryngology (421) Pain Medicine (436) Palliative Medicine (130) Pathology (665) Pediatrics (1696) Pharmacology and Therapeutics (693) Primary Care Research (714) Psychiatry and Clinical Psychology (5461) Public and Global Health (9252) Radiology and Imaging (2207) Rehabilitation Medicine and Physical Therapy (1371) Respiratory Medicine (1197) Rheumatology (597) Sexual and Reproductive Health (715) Sports Medicine (530) Surgery (714) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a02baf343fb1f478',t:'MTc3OTk1NDc5Mw=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();