Exploring HIV prevention utilization among female sex workers and male-to-female transgenders.

Female sex worker (FSW) and male-to-female transgender (TGW, transgender women) populations both experience elevated levels of HIV infection and have unique prevention needs because of their stigmatized social status and often-precarious economic circumstances. We analyzed data from 104 FSWs and 128 TGW to assess their level of exposure to active and passive HIV prevention services and identify which subgroups are underserved. Data were collected, in Los Angeles for the cross-sectional 2003-2004 HIV Testing Survey (HITS), through face-to-face interviews with participants recruited primarily from street, club, and social service venues. Both groups reported more passive than active prevention exposure, with overall participation less common for FSWs than for TGW. Although some differences were observed between groups, predictors of lower HIV prevention utilization identified in both study populations included African American (versus Hispanic) race/ethnicity, higher household incomes, cohabitation/marriage, and not seeking recent health care. Prevention efforts should increase outreach to these subgroups, tailor programs for those who are African American or partnered, and increase the proportion of FSWs and TGW who periodically engage in active HIV prevention services such as client-centered counseling and small-group interventions to build skills related to safer sex.