Date of Award

Spring 5-13-2016

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Laura F. Salazar

Second Advisor

Eric R. Wright

Abstract

INTRODUCTION: Transgender women’s experiences of violence and transphobia can negatively affect health outcomes and influence health behavior. Transgender women and especially African-American transgender women suffer a disproportionate burden of HIV and may have unique experiences around both race and gender, which involves an added layer of discrimination. According to the gender affirmation framework, the stigma associated with being a transwoman of color could be a primary driver for engaging in high-risk behavior.

AIM: The present study aims to determine how gender discrimination relates to HIV status, affects quality of life, and influences engaging in risky sexual behaviors or substance use. Additionally, the link between gender discrimination and gender affirmation was assessed and whether gender affirmation moderated the relationships between gender discrimination and HIV or quality of life.

METHODS: African-American transgender women were recruited with the assistance of transgender advocates and local community organizations. Face-to-face interviews with participants were conducted and their responses were recorded on a tablet. Data were collected from October 2014 to June 2015.

RESULTS: The sample consisted of 77 women with a mean age of 35 years old; approximately 40% of the sample was currently unemployed with an average annual income of less than $10,000. Additionally, 67% of the sample reported being HIV-positive. There was a significant interaction effect of gender affirmation and gender discrimination (i.e., ever being hit or beaten after disclosing) on quality of life (p < .001). A linear regression analysis revealed three gender discrimination items influenced quality of life: experiencing verbal abuse or harassment by a stranger (β = -.327, p <.01), ever being in situations where not disclosing put them in physical danger or harm (β = -.305, p < .05), and having problems getting health or medical services (β = .268, p < .05). A binary logistic regression analysis revealed a significant relationship between HIV status and experiencing verbal abuse or harassment by a family member or friend (AOR = .103, p < .05).

DISCUSSION: Women who reported higher levels of gender affirmation and experiencing physical violence after disclosing reported higher levels of quality of life than those who reported low levels of gender affirmation, indicating gender affirmation could be a potential protective factor for those who experience this type of discrimination. Quality of Life was the outcome most impacted by gender discrimination, and future interventions should focus on improving the quality of life of transgender women by decreasing transphobia and increasing resources for transwomen, regardless of HIV status.

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