Drugs, Unsafe Sex Common Among Men Living as Women

[NEW YORK] - Men who live their lives as women, also known as male-to-female transgenders, have high rates of drug use and often have sex while on drugs, US researchers report.

The current study also matched previous reports that showed this population has high rates of diseases linked to unsafe practices related to sex and drug use. Indeed, Dr. Don Operario and his colleagues at the University of California, San Francisco, found that 42% of African-American men living as women have HIV (news - web sites).

Among those who used injection drugs, the rate of HIV soared to 56%, the researchers report.

These findings demonstrate that transgenders are "facing overwhelming public health crises," Operario told Reuters Health, and their needs should be addressed.

"Transgender communities are one of the most understudied and underserved communities in the country," Operario said.

The current findings are based on interviews with 332 male-to-female transgenders, all of whom belonged to an ethnic minority. Some of the participants had undergone operations to physically change their genders. Operario and his colleagues presented their findings at the recent 130th Annual Meeting of the American Public Health Association (news - web sites) in Philadelphia.

The researcher discovered that the majority of the people interviewed said they had used drugs, and more than half of the total group reported having had sex while using drugs during the past 30 days.

Among those who said they had experienced unprotected anal sex during the past 30 days while on drugs, most of the incidents occurred while they were drinking alcohol or using a stimulant such as crack or cocaine. Almost one third of those who had unprotected sex while on drugs did so with someone who had paid them for sex.

Among injection drug users, approximately half said they shared needles and one third reported sharing cookers, paraphernalia used to prepare drugs. Not surprisingly, one third of those who said they had used injection drugs within the past 30 days had hepatitis C.

In an interview with Reuters Health, Operario said that the relatively high rates of drug use and sexual risk-taking likely stems from "multiple, multiple levels of depression, from discrimination to lack of healthcare."

Living as a transgender can be extremely difficult, Operario said, and transgenders often suffer from depression and low self-esteem. It is hard to get a job when you look like a member of another gender, he said, and many feel alienated from society and their families.

"Imagine telling your parents you no longer identify with the birth gender they raised you as," he said.

As a result, many male-to-female transgenders leave home early, and do not continue their education--which often only adds to the discrimination they face, Operario noted.

Based on these findings, Operario and his colleagues recommend that drug treatment programs try to target the specific psychological and social needs of transgenders. In addition, Operario said he believed male-to-female transgenders would benefit greatly from doctors who are aware of their specific health needs, such as hormone use, and who understand their lifestyles.

Transgenders "need providers that know something about transgender care," Operario said.