Transgender women’s alcohol use and HIV high-risk behaviors in the Dominican Republic

Abstract

Background: Studies on alcohol use in transgender populations, particularly those in global resource-limited settings are scarce. This is particularly alarming, since alcohol use may be both a facilitator of HIV risk behaviors and a coping mechanism used after the engagement in such activities. Thus, we examined the relationships between high-risk sexual practices and alcohol use in a national sample of transgender women from the Dominican Republic. Methods: Data for this study was from the 2015 Dominican Republic Transgender Health Needs Study (THNS), collected by Centro de Orientación e Investigación Integral (COIN), and funded by the National Council for HIV and AIDS (CONAVIHSIDA) representing the Dominican Republic Ministry of Health. As recommended by the Joint United Nations Programme on HIV/ AIDS (UNAIDS), this study leveraged the PLACE method of data collection. Bivariate analysis examined differences between routine alcohol users and abstainers (n=291). Multivariate analyses reported odds ratios with alcohol use during sexual activity as the outcome (n=245). Results: About half of respondents (49.5%) had sex under the influence of alcohol in the last 30 days, and 37.1% reported income from sex work. Bivariate tests found significant differences between alcohol users and abstainers. Sex workers (defined as reporting primary or secondary income through sex work), respondents who engaged in high-risk sexual behaviors, those who used condoms less frequently, and respondents reporting higher numbers of sexual partners were all more likely to consume alcohol regularly as compared to their peers (p Conclusions: Significant knowledge gaps persist in the behaviors of transgender women in resource-limited settings, especially in the Spanish speaking Caribbean. Although cross-sectional data cannot offer causal inferences, the associations between alcohol use and sex work in the transgender women from our national sample is particularly alarming, since alcohol consumption has been well-documented as an associate of engagement in high-risk for HIV sexual behaviors. Furthermore, transgender women are stigmatized in the Dominican Republic, potentially limiting their work opportunities. Anti-discrimination laws to exist that protect workers, but those policies are not consistently enforced potentially forcing transgender women to seek work in alternative settings. Further research on if alcohol enables the entry into sex work, if it reduces psychosocial effects of being a sex worker, or both is necessary to develop culturally appropriate, effective harm-reduction strategies for transgender women in the Dominican Republic.