A new study from North Carolina State University shows that talking about safer sex is a complicated process for individuals in the transgender community. The finding may help efforts to promote safer sex practices in a community facing high HIV rates - and also sheds light on broader questions related to safer sex for everyone.
"The main reason for this study is the fact that we're seeing evidence of devastatingly high HIV prevalence rates in the transgender community," says Dr. Kami Kosenko, an assistant professor of communication at NC State and lead author of the study. "The HIV prevalence rate is less than 1 percent for the general U.S. population. But for the transgender population, the HIV prevalence rate is estimated to be as high as 60 percent in major metropolitan areas. Although these are only estimates, they are troubling."
The term transgender is used to refer to people who are uncomfortable with their assigned gender identity, including individuals who establish a gender identity that does not comply with traditional gender roles. For example, the term often applies to individuals whose gender presentation differs from their biological sex.
These high HIV prevalence rates have led to efforts from researchers, public-health officials and others to help the transgender community do a better job of communicating about safer sex practices. Kosenko's research stems from "a need to better understand how transgender individuals talk about sex, to make sure that safer sex educational efforts targeting this community are effective."
Kosenko notes that research on sexual communication in general is fairly limited. Historically, sex communication research has defined safer sex discussions as one of two things: finding out about a partner's sexual history; or trying to persuade a partner to use a condom.
What Kosenko found is that communication about safer sex, at least in the transgender community, is far more complicated.
After interviewing 41 transgender individuals from around the country, Kosenko found, for example, that privacy is a significant issue. Transgender individuals have to make often-difficult decisions about when and how to disclose their biological sex to prospective partners - because that revelation carries the risk of rejection, or even violent behavior.
But other findings from the study may be applicable beyond the transgender community. Kosenko found that transgender individuals - like people in other groups - try to gauge sexual health risks by talking to prospective partners about their sexual history and safer sex practices. But Kosenko also found that these talks can be undermined if a partner is being dishonest about his or her past - a problem that is presumably faced by those outside the transgender community as well.
"This study shows that understanding sexual communication goes beyond attempts to discuss sexual history," Kosenko says. "It also entails the difficult process of trying to determine if a sexual partner is being forthcoming."
In addition, the study found that talking about safer sex is about more than using condoms. For example, in the transgender community, some people go through the process of getting tested for sexually transmitted diseases with a partner and then having unprotected sex if both test negative for HIV. The partners also establish rules for sexual activity outside the relationship. For instance, are outside relationships acceptable if condoms are used?
"I think these findings will help us provide safer sex outreach tools for the transgender community that are based in reality," Kosenko says. "And a lot of what we found in this study applies to sexual communication outside of the transgender community as well. Pushing for people to always use condoms may be impractical. Perhaps it would be more effective to promote a broader definition of safer sex practices."
A paper describing the study, "The Safer Sex Communication of Transgender Adults: Processes and Problems," is published in the June issue of the Journal of Communication. The research was funded by the National Institute of Mental Health.