Caught between different worlds: How transgendered women may be "forced" into risky sex

We qualitatively explored reasons why transgendered women may engage in sexual risk that could lead to HIV infection. Specifically, we conducted this investigation with transgendered women identifying as Black/African American. Interviews from 17 participants were audiotaped and analyzed. Four themes emerged. Women commonly reported they had a strong need/desire to be loved by men. Many stated they had and would engage in unprotected sex to obtain and preserve such a relationship. Nearly all were currently using female hormones. Nine obtained their hormones through nonmedical means, including the Internet, transgendered friends, and street vendors. For these women, hormone injections often involved sharing needles/syringes. Selling sex was a common practice, and many women did so without the benefit of condom use. Finally, women experienced multiple forms of societal discrimination. By being caught between worlds (straight, gay, male, and female), transgendered women may be placed into situations in which avoiding HIV risk is extremely difficult.