Sex, drugs, and the culture of transvestimo in Rio de Janeiro

Transvestites in Brazil are members of an intricate and distinct subculture whose marginalization uniquely impacts the effectiveness of HIV prevention/intervention programs. As such, the purpose of this research was to assess the drug using and sexual behaviors, and prevalence of HIV-1 infection among a sample of 100 male transvestite sex workers, and to develop appropriate intervention strategies. AIDS risk behaviors were common among the transvestites studied, and almost half tested positive for HIV infection. Recommendations for prevention efforts include the incorporation of condom negotiation and empowerment techniques. Female condom demonstration and distribution (for anal sex) should also be included since the findings show it was well-received by transvestites. Finally, nearly all of the clients reported non-hygienic use of needles for silicone injections, suggesting that needle cleaning techniques also should be included in future prevention initiatives targeting transvestite sex workers. In Brazil, transvestism is a specific social and cultural construct in which both gender and sexuality are mapped out and performed in highly particular ways (1). Moreover, it has a long history, both as an integral theme during Carnaval, and as a gender variation with its own distinct culture (2,3,4). At Carnaval, best described as an enthusiastically celebrated street festival and parade during the five days prior to Ash Wednesday, many males - both gay and heterosexual - participate dressed as women, not only to glorify and venerate women, but also as a projection of male sexual fantasies (4). In contrast to Carnaval cross-dressing, the travestis of Brazil view transvestism as an identity and a designation that pervades every aspect of their lives. Although the clinical literature emphasizes that transvestites do not live continuously in the cross-gender role, and that their cross-dressing is periodic and fetishistic (6,7), for the travestis of Brazil, transvestism appears to be enduring - typically life long. Transvestites in Brazil, as in other cultures, are marked by an exaggerated femininity in both dress and makeup. They come almost exclusively from the poorest segments of Brazilian society, but there is little toleration for them in either the favelas (shantytowns) or the traditional, low income suburban areas. Thus, as they begin to cross the lines of gender, most leave behind family and friends, emigrating to Rio de Janeiro, Sao Paulo, and other large cities into districts where: . . . a mixture of socially marginal and often illegal activities creates not only a kind of moral region but a moral anonymity in which the traditional values of Brazilian society cease to function. Within this world (which is also the world of female prostitution, drug trafficking, homosexuality, and the more sporadic prostitution of the miches [male prostitutes]), given pervasive prejudice and discrimination, almost no options other than prostitution are open to the travesti for earning a living; as a result, almost all travestis quickly become involved in prostitution as their primary activity (8). Most transvestites live in close proximity to each other, and they always dress as women. Many use drugs, and because of their involvement in street prostitution, they are regularly exposed to both violence and a full range of sexually transmitted diseases, including HIV and AIDS. For example, among 57 drug-using transvestites engaging in prostitution in Rome (the great majority of whom had emigrated from Brazil), the overall prevalence of HIV was 74% (9). Studies conducted in various parts of Brazil over the past ten years also reflect high rates of HIV seropositivity among transvestite sex workers. Among 37 transvestites tested in Sao Paulo during 1988, 62% were found to be HIV positive (10), and among 112 transvestites contacted four years later, 60.7% tested positive (11). In Rio de Janeiro, it is estimated that there are at least 2,000 transvestites, (and they prefer the term "transvestite," or travesti in Brazilian Portuguese, as opposed to transsexual or transgender), 80% of whom support themselves through prostitution. Within this context, the following discussion examines aspects of the subculture of male transvestite sex workers in Rio de Janeiro, with a particular focus on their drug-using and sexual risk behaviors.