L. Pollock1, K. Konda2, J.D. Klausner1, S. Leon3, E. Lugo3, J. Cuadros3, J. Galea2, T. Coates2, C. Cáceres3
1University of California, San Francisco, San Francisco, United States, 2University of California, Los Angeles, Los Angeles, United States, 3Universidad Peruana Cayetano Heredia, Lima, Peru
Background: For MSM and transgender (male-to-female) women, exposure to homophobia and transphobia forms the context for extreme social marginalization; there is evidence that this exposure increases sexual risk-taking. We explored the relationship between homophobia, gender identity, and sexual risk-taking behaviors.
Methods: Data was collected at the baseline of an HIV prevention trial, Peru Positive Communities Trial, with men and transgender women reporting anal intercourse with a man in the past year in Lima, Peru. The face-to-face interview included a 12-item scale regarding exposure to homophobia. We dichotomized each item; “always” and “almost always” equaled yes, and other responses equaled no. A 12-point score was created summing dichotomized responses. Comparisons were made using median or chi-square tests, as applicable.
Results: Chrombach’s alpha of the 12-item scale was 0.73. The 12-point score differed significantly by sexual identity; median (interquartile range) among transgender women (n=208) was 3 (1-5) and among gay/bisexual men (n=509) was 2 (1-4) (p< 0.001). By item, transgender women reported as a child they were made fun of (37%), physically assaulted (18%), or felt that their identity made their family suffer (41%) versus in gay/bisexual men (25%, 6%, 27%) (all p< 0.001). As adults, transgender women reported having been physically assaulted (5%); lost work or schooling opportunities (14%); and been harassed by police (23%) versus gay/bisexual men (0.4%, 5%, 5%) (all p< 0.001). In simple linear regression, mean number of sex partners in past 3 months increased by 0.18 (p< 0.001) for a 1-point increase in homophobia score, controlling for sexual identity.
Conclusions: Transgender women reported greater exposure to homophobia, and homophobia was associated with increased number of sex partners. The association between exposure to homophobia and risk behavior needs to be explored further. For transgender women, homo/transphobia is a significant experience that may contribute to an environment of increased risk and vulnerability.