Psychosocial contributing to a syndemic of substance use and HIV risk among Floridian transgender women

BackgroundTransgender women are at heightened risk of HIV and substance misuse due to systemic discrimination and structural healthcare barriers at the macro, meso, and micro levels. Floridian Transgender Women (FTW) face unique challenges in an environment with limited resources and inconsistent epidemiological data. Syndemic theory, which examines how co-occurring conditions like HIV and substance use disorders (SUD) are driven by large-scale factors, has not been fully explored in FTW. ObjectiveThis study aimed to identify psychosocial factors contributing to substance use and HIV risk from a syndemic perspective among FTW. MethodsFrom May 2021 to November 2023, over 500 at-risk FTW were recruited from community partner agencies in Miami-Dade and Orlando counties for a larger prospective study. Univariate analysis identified psychosocial factors, while bivariate analysis explored their contributions to the syndemic of substance misuse and HIV risk. ResultsOut of 160 participants screened, 55.6% were ineligible, leaving 89 enrolled. Participants ranged in age from 18 to 63, with 25% identifying as people of color. Mental illness was reported by 62.9%, with depression and anxiety being the most common diagnoses. However, only 29.2% had accessed mental health care in the past year. Despite high rates of substance use--48.8% reported drug use during sex, 46.1% likely had an SUD, and 25.8% reported hazardous drinking--68.9% perceived their quality of life as high. Drug use during sex was significantly associated with intimate partner violence (IPV) (p=.01) and perceived quality of life (p=.003). ConclusionFTW face significant challenges, including discrimination, mental illness, trauma, and IPV, which increase the risk of substance use, particularly marijuana and alcohol. Despite these challenges, many maintain a high perceived quality of life. The syndemic interaction calls for comprehensive interventions addressing financial, mental health, and accessibility barriers. Further research into socio-political stressors that exacerbate substance use and high-risk behaviors is recommended.