The social organization of transvestite prostitution and AIDS

This paper reports on the social organization of 53 transvestite prostitutes in Atlanta (GA), U.S.A. The central focus of the paper is on the relationship between social organization, social networks, and HIV risk behaviors in three geographic areas. In one of the areas the HIV infection rate was significantly higher than in the other two areas (81.1% vs 62.5% and 12.5%). Transvestites from the high prevalence area are strongly committed to transvestism and, consequently, are socially isolated. They report the lowest income, engaged in passive anal sex, have a history of syphilis and report inconsistent condom use with paying sex partners. Transvestite prostitutes in the other two areas are less committed to transvestism and more integrated into non-transvestite networks. In the area with the lowest HIV rate the transvestites are integrated into the non-transvestite male prostitute social organization so are discouraged from engaging in receptive anal sex, especially without condoms. The differences in HIV seroprevalence as well as related behavioral differences are linked to social organization among the transvestite prostitutes and to their participation in risky sex such as receptive anal intercourse.