Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization

Am J Public Health. 2012 Sep;102(9):1751-7. doi: 10.2105/AJPH.2011.300433. Epub 2012 Feb 16.


Objectives: We assessed whether multiple psychosocial factors are additive in their relationship to sexual risk behavior and self-reported HIV status (i.e., can be characterized as a syndemic) among young transgender women and the relationship of indicators of social marginalization to psychosocial factors.

Methods: Participants (n = 151) were aged 15 to 24 years and lived in Chicago or Los Angeles. We collected data on psychosocial factors (low self-esteem, polysubstance use, victimization related to transgender identity, and intimate partner violence) and social marginalization indicators (history of commercial sex work, homelessness, and incarceration) through an interviewer-administered survey.

Results: Syndemic factors were positively and additively related to sexual risk behavior and self-reported HIV infection. In addition, our syndemic index was significantly related to 2 indicators of social marginalization: a history of sex work and previous incarceration.

Conclusions: These findings provide evidence for a syndemic of co-occurring psychosocial and health problems in young transgender women, taking place in a context of social marginalization.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Chicago / epidemiology
  • Crime Victims / statistics & numerical data
  • Data Collection
  • Domestic Violence / statistics & numerical data
  • Female
  • HIV Infections / complications
  • HIV Infections / epidemiology*
  • HIV Infections / psychology
  • HIV*
  • Humans
  • Los Angeles / epidemiology
  • Psychology / statistics & numerical data*
  • Risk Factors
  • Risk-Taking
  • Self Concept
  • Sexual Behavior
  • Substance-Related Disorders / epidemiology
  • Transsexualism / complications
  • Transsexualism / epidemiology*
  • Transsexualism / psychology
  • Young Adult