Factors Associated with Arrest Among a Sample of HIV-Positive Transgender Women of Color

Background and purpose: Transgender adults, particularly transgender women of color, experience high rates of criminal legal system involvement compared to the general population. This disproportionality is likely driven to an extent by police harassment and violence. Evidence suggests that criminal legal system involvement is related to poorer health outcomes, including greater likelihood of HIV-positive status. Experiences within prisons and jails may contribute to health disparities, for example, transgender individuals are routinely denied access to transgender-affirming medical care, hormones, and HIV medication in detention facilities. To date, few studies have explored the factors contributing to high arrest and incarceration rates among this population and potential associations with HIV status. Limited research suggests experience of social and structural marginalization (i.e. poverty, violence) may contribute to and be exacerbated by both HIV status and criminal legal system involvement. The purpose of this study is to assess if these and related factors are associated with arrest among HIV+ transgender women of color (TWOC).

Methods: Data for this study were obtained from the baseline interviews of 224 HIV+ TWOC collected between 2013-2016 in Chicago as part of a HRSA-funded multisite study to promote engagement in HIV treatment. Multivariable logistic regression was used to identify factors associated with a history of arrest. All statistical analyses were conducted using SPSS version 23.

Results: The mean age of the sample was 32.6 years (SD= 10.6) and the majority of participants (862.6%) reported income of less than $12,000 annually. A total of 37.9% of respondents reported a history of verbal harassment by police attributed to transgender identity and/or expression, and 19.2% reported ever being hit, shoved, or beaten up by police. Just under 38% of participants reported a prior arrest. Of those previously arrested and detained, the majority (89.6%) reported being housed with men in their last detention facility; 28.4% reported needing HIV medications but not receiving them; and 50.6% reported needing hormones but not receiving them. In the multivariable model, income (OR=.510, p<.01), age (OR=1.06, p<.01), and engagement in sex work (OR=4.28, p<.01) were significantly associated with arrest.

Conclusions and implications: Participants reported high levels of police harassment and violence, with additional evidence indicating a sizable proportion of those arrested are denied access to HIV and transgender-related medical care. These findings suggest the need for policy reforms related to the treatment of transgender individuals by police and provision of HIV and transgender-affirming medical care in detention facilities. In addition to documenting TWOC’s negative experiences within the criminal legal system, this study identified poverty and engagement in sex work as factors associated with prior arrest history. These findings indicate the need to consider the role these and other forms of social and structural marginalization play in criminal legal system involvement and recidivism in order to better design programs and policies aimed at deterring HIV+ TWOC from arrest and incarceration.