Beyond Risk : Experiences of Strength and Resilience Among Transgender Women Living with HIV

Background: Scholars have documented HIV prevalence rates between 14% to 68% for transgender (TG) women in the US, making them the most vulnerable group at risk for HIV (Herbst et al., 2007; Rodriguez-Madera & Toro-Alfonso, 2005). In particular, homeless TG women experience myriad risks such as stigma, violence and negative mental health outcomes that exacerbate their risk (Operario & Nemoto, 2010). However, the emphasis on homeless, HIV-positive TG women’s risk factors has deflected from the strategies they deploy to negotiate their risk environments. We counter this risk-focused discourse by examining strategies based on positive self-definitions and resilience among homeless seropositive TG women upon which strengths-based social work interventions can be built.

Methods: 30 in-depth semi-structured interviews were conducted with homeless or unstably housed TG women living with HIV. Participants were recruited through convenience sampling and were asked about their experiences with housing, violence, access to medical services, and social support. A grounded theory approach was utilized to code and analyze the data (Charmaz, 2006).

Results: Participants discussed relying on strategies based in multiple sources of strength and resilience:

Strength in Gender Identity: Resisting the idea of TG identity as a risk factor, many participants reported gender identity as a source of pride and chosen gender expression as a positive incentive for attaining health goals.

Social Networks: Belying flat narratives of family rejection and deviant peer groups, participants described broad social networks of family, friends, and intimate partners. Relationships within the TG community were a particular source of strength, providing opportunities to give and receive mentorship support, learn about available resources, and stay safe in the risk environment.

Strategic Engagement with Systems: Importantly for social work research, participants reported many negative experiences with social services. Within a discriminatory service environment, TG women reported strategies to maximize benefits of program participation as a path to achieve larger life goals.

Advocacy: Previous experience with advocacy initiatives translated to a desire for greater involvement with advocacy efforts and active participation in social services and research.

Implications: Maximizing these sources of strength and resilience is critical to effective social work engagement with transgender clients. This research articulates specific sources of strength upon which social work interventions can build. Interventions can support TG women by including chosen gender identity expression as a key component of holistic physical and mental health care. Social workers can build upon existing social networks traditionally undervalued for TG women, specifically through interventions designed to leverage existing transgender peer supports. Social service organizations can integrate feedback from TG clients regarding specific strategies to recognize and combat gender discrimination. Finally, social workers can build upon positive TG advocacy experiences to support TG women as agents of social change. Such interventions are needed if the field of social work is to support transgender women as complete human beings and not simply as sites of risk.