SPECIFIC AIMS: The proposed study will investigate the determinants of drug and hormone use and HIV risk and protective behaviors among the following target groups: male-to-female transgenders of color, including African American, Asian and Pacific Islander (API), and Latina transgenders, who have engaged in commercial sex in San Francisco. Transgenders are defined as self-identified pre-gender confirmation surgery (pre-operative) or post-gender confirmation surgery (post-operative) male-to- female transgenders. The objectives of the study are: 1) To clarify the relationships between behaviors of injecting hormones and sharing paraphernalia for both hormone and drug use with private sex partners, friends, and customers of commercial sex workers, 2) To determine intervening factors such as cognitive, cultural, and socioeconomic factors, and to describe their relationships with drug and hormone use and HIV risk and protective behaviors among the target groups, and 3) To disseminate the research findings through local and national networks among transgenders of color and AIDS service organizations. METHODS: The study has three stages: 1) Preparation of the study, including focus groups, mapping, training staff, and a pilot study, 2) Conducting survey interviews, and 3) Data analyses and dissemination of the study findings. Six focus groups (2 for each racial group) will be conducted to describe drug and hormone use and issues and concerns related to HIV risk and protective behaviors among the target groups. The focus group data will be analyzed by qualitative methods to examine the working hypotheses and conceptual models of the study. Based on the focus groups, mapping, and pilot study (60 survey interviews), the culturally comparable and transgender sensitive survey questionnaire and procedures will be finalized. A total of 300 one-on-one interviews with transgenders of color (100 for each racial group) using a structured survey questionnaire will be conducted. Utilizing the targeted sampling methods, the participants for the study will be recruited from the transgender client populations in the collaborating agencies and from transgender commercial sex workers on the street. The specific hypotheses and theoretical models for the determinants of HIV risk and protective behaviors will be tested quantitatively based on the survey data. The study findings from the focus groups and survey interviews will be integrated to attain the study objectives. SIGNIFICANCE: This study will provide a systematic description of drug and hormone use and HIV risk and protective behaviors of transgenders of color where risk and urgent needs for interventions are evident, but research has thus far been limited. The study findings which clarify the relationships among behaviors of injecting hormones and drugs, HIV-related behaviors, and the determinants of these behaviors, will be utilized at the collaborating community agencies to further understand the target groups and will lay the groundwork for developing intervention studies in the future.
