SPECIFIC AIMS: The proposed continuation study will expand the sample to further investigate the determinants of drug use and HIV risk behaviors among male-to-female (MTF) transgenders. The continuation study will target MTF white transgenders in San Francisco and African Americans in Oakland, CA. The recruitment of these groups in addition to the current study samples of African American, Asian and Pacific Islander (API), and Latina transgenders in San Francisco, is necessary to investigate ethnic and community differences in drug use and HIV risk behaviors in relation to cognitive and sociocultural factors. The objectives of the study remain same: 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, 2) To determine intervening factors such as cognitive and sociocultural factors, and to describe their relationships with drug and hormone use and HIV risk behaviors among the target groups, and 3) To disseminate the research findings through local and national networks among transgenders and AIDS service organizations. METHODS: The continuation 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 study findings. Four focus groups (2 from whites and 2 from African Americans) will be conducted to describe drug and hormone use and issues and concerns related to HIV risk behaviors for each target group. The focus group data will be analyzed by qualitative methods to examine the hypotheses and conceptual models of the study. Based on the focus groups, mapping, and a pilot study, the survey questionnaire and procedures will be examined and finalized to be compatible to those in the current study. A total of 220 individual interviews with transgenders (110 for each group) will be conducted, using a structured survey questionnaire similar to the current study. Utilizing the targeted sampling methods, participants for the study will be recruited from the transgender client population in the collaborating agencies and from the transgender sex worker population on the street. The specific hypotheses and theoretical models for the determinants of HIV risk behaviors and heath outcomes will be tested qualitatively and quantitatively based on the focus group and 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 use and HIV risk behaviors among transgenders where risk and urgent needs for interventions are evident, but research has thus far been limited. The study findings will clarify ethnic and community differences in drug use and HIV risk behaviors in relation to cognitive and sociocultural factors, and will be utilized at the collaborating community agencies to further understand the target groups and lay the groundwork for developing intervention studies in the future.
