Substance Misuse and Condomless Sex Among Transgender Youth
Abstract
Purpose: The purpose of this research is to explore the relationship between substance use and sexual risk behaviors among transgender youth.
Methods: Data from the transgender subsample of the Survey of Today's Adolescent Relationships and Transitions (n=1567) were analyzed to assess associations between substance misuse (binge drinking, prescription drug misuse, illicit drugs) and sexual risk behaviors (condom use during sex). Multivariate logistic regression models calculated adjusted odds ratios (AORs) for substance use by sexual risk behavior controlling for race/ethnicity, gender identity (transgender male, transgender female, genderqueer/gender nonconforming), age, sexual identity, and region.
Results: Among participants, lifetime marijuana use (AOR=0.45), cocaine use (AOR=0.46), prescription drug misuse (AOR=0.52), and injecting substances with a needle (AOR=0.45) were all associated with lower odds of reporting condom use during the last act of receptive anal sex. Similarly, marijuana use in the last 30 days (AOR=0.46), lifetime marijuana use (AOR=0.25), heroin use (AOR=0.29), methamphetamine use (AOR=0.32), misuse of prescription drugs (AOR=0.40), and injecting substances with a needle (AOR=0.17) were all associated with lower odds of reporting condom use during the last act of insertive anal sex. No associations between substance use and condom use during last act of receptive frontal (vaginal) sex were found.
Conclusion: We found that transgender youth who reported any lifetime substance use were more likely to report condomless sex during receptive and insertive anal sex than those who did not report substance use. Significant differences exist among demographic groups, type of substance use, and sexual risk behaviors for respondents based on gender identity.
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The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
References
1. Becasen JS, Denard CL, Mullins MM, et al. Estimating the prevalence of HIV and sexual behaviors among the US transgender population: a systematic review and meta-analysis, 2006–2017. Am J Public Health. 2019;109:e1–e8.
2. Centers for Disease Control and Prevention. HIV surveillance report, 2018 (Updated); vol. 31. 2020. Available at https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-updated-vol-31.pdf Accessed November 17, 2020.
3. Herbst JH, Jacobs ED, Finlayson TJ, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12:1–17.
4. Hafeez H, Zeshan M, Tahir MA, et al. Health care disparities among lesbian, gay, bisexual, and transgender youth: a literature review. Cureus. 2017;9:e1184.
5. Johns M, Lowry R, Andrzejewski J, et al. Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. MMWR Morb Mortal Wkly Rep. 2019;68:67–71.
6. Reback CJ, Fletcher JB. HIV prevalence, substance use, and sexual risk behaviors among transgender women recruited through outreach. AIDS Behav. 2014;18:1359–1367.
7. Barnett A, Ruiz MS, Zea MC. Chapter 4: Transgender Adolescents and Transactional Sex, from Transgender Youth: Perceptions, Media Influences, and Social Challenges. New York: Nova Publishers, 2016.
8. Reisner SL, Jadwin-Cakmak L, Sava L, et al. Situated vulnerabilities, sexual risk, and sexually transmitted infections' diagnoses in a sample of transgender youth in the United States. AIDS Patient Care STDs 2019;33:120–130.
9. Wilson EC, Garofalo R, Harris DR, Belzer M. Sexual risk taking among transgender male-to-female youths with different partner types. Am J Public Health. 2010;100:1500–1505.
10. Reisner SL, Greytak EA, Parsons JT, Ybarra ML. Gender minority social stress in adolescence: disparities in adolescent bullying and substance use by gender identity. J Sex Res. 2015;52:243–256.
11. Bonar EE, Cunningham RM, Chermack ST, et al. Prescription drug misuse and sexual risk behaviors among adolescents and emerging adults. J Stud Alcohol Drugs. 2014;75:259–268.
12. Clayton HB, Lowry R, August E, Everett Jones S. Nonmedical use of prescription drugs and sexual risk behaviors. Pediatrics. 2016;137.
13. Ritchwood TD, Ford H, DeCoster J, et al. Risky sexual behavior and substance use among adolescents: a meta-analysis. Child Youth Serv Rev. 2015;52:74–88.
14. Ritchwood TD, DeCoster J, Metzger IW, et al. Does it really matter which drug you choose? An examination of the influence of type of drug on type of risky sexual behavior. Addict Behav. 2016;60:97–102.
15. Vasilenko SA, Lanza ST. Predictors of multiple sexual partners from adolescence through young adulthood. J Adolesc Health. 2014;55:491–497.
16. Brennan J, Kuhns LM, Johnson AK, et al. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health. 2012;102:1751–1757.
17. Hotton AL, Garofalo R, Kuhns LM, Johnson AK. Substance use as a mediator of the relationship between life stress and sexual risk among young transgender women. AIDS Educ Prev. 2013;25:62–71.
18. Reisner SL, Vetters R, White JM, et al. Laboratory-confirmed HIV and sexually transmitted infection seropositivity and risk behavior among sexually active transgender patients at an adolescent and young adult urban community health center. AIDS Care. 2015b;27:1031–1036.
19. 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. 2017;38:419–445.
20. Benotsch EG, Zimmerman R, Cathers L, et al. Non-medical use of prescription drugs, polysubstance use, and mental health in transgender adults. Drug Alcohol Depend. 2013;132:391–394.
21. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674.
22. Hatzenbuehler ML, Pachankis JE. Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth: research evidence and clinical implications. Pediatr Clin North Am. 2016;63:985–997.
23. Testa RJ, Habarth J, Peta J, et al. Development of the gender minority stress and resilience measure. Psychol Sex Orientat Gend Divers. 2015;2:65–77.
24. Millar BM, English D, Moody RL, et al. Day-level associations between substance use and HIV risk behavior among a diverse sample of transgender women. Transgend Health. 2018;3:210–219.
25. Clayton H, Andrzejewski J, Johns M, et al. Does the association between substance use and sexual risk behaviors among high school students vary by sexual identity? Addict Behav. 2019;93:122–128.
26. Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005;19:S67–S72.
27. Prescott TL, Phillips II G, DuBois LZ, et al. Reaching adolescent gay, bisexual, and queer men online: development and refinement of a national recruitment strategy. J Med Internet Res. 2016;18:e200.
28. Fordyce E, Heim Viox M, Stern MJ, et al. Social media recruitment for adolescent sexual minority males and transgender youth. Alexandria, VA: American Statistical Association. JSM Proceedings 2018.
29. Becasen JS, Denard CL, Mullins MM, et al. Estimating the prevalence of HIV and sexual behaviors among the US transgender population: a systematic review and meta-analysis, 2006–2017. Am J Public Health. 2019;109:e1–e8.
30. Jordan KM. Substance abuse among gay, lesbian, bisexual, transgender, and questioning adolescents. Sch Psychol Rev. 2000;29:201–206.
31. Newcomb ME, Heinz AJ, Mustanski B. Examining risk and protective factors for alcohol use in lesbian, gay, bisexual, and transgender youth: a longitudinal multilevel analysis. J Stud Alcohol Drugs. 2012;73:783–793.
32. Wallace D, Cesar G, Hedberg EC. The effect of survey mode on socially undesirable responses to open-ended questions: A mixed methods approach. Field Methods 2018;30.2:105–123.
Cite this article as: Schlissel AC, Carpenter R, Avripas S, Heim Viox M, Johns MM, Harper C, Michaels S, Dunville R (2022) Substance misuse and condomless sex among transgender youth, Transgender Health 7:4, 314–322, DOI: 10.1089/trgh.2020.0115.
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Published In
Transgender Health
Volume 7 • Issue Number 4 • August 2022
Pages: 314 - 322
Copyright
Copyright 2022, Mary Ann Liebert, Inc., publishers.
History
Published in print: August 2022
Published online: 1 August 2022
Published ahead of print: 30 June 2021
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Authors' Contributions
All coauthors contributed to drafting and revising the article. A.C.S. and R.C. shared responsibility for conducting all analyses and interpreting the data. A.C.S., S.A., M.H.V., M.M.J., C.H., S.M., and R.D. assisted in the conception and design of the study. All coauthors have reviewed and approved of the article before submission.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
Funding for this work was provided by the Centers for Disease Control and Prevention contracts GS-10F-0033M/HHSD2002013M53955B/200-2015-F-88276 and 200-2018-F-03525.
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