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Sex Roles (2013) 68:675689 DOI 10.1007/s11199-012-0216-5
ORIGINAL ARTICLE
Gender Affirmation: A Framework for Conceptualizing Risk Behavior Among Transgender Women of Color
Jae M. Sevelius
Published online: 30 September 2012# Springer Science+Business Media New York 2012
Abstract Experiences of stigma, discrimination, and violence as well as extreme health disparities and high rates of sexual risk behavior and substance use have been well-documented among transgender women of color. Using an intersectional approach and integrating prominent theories from stigma, eating disorders, and HIV-related research, this article offers a new framework for conceptualizing risk behavior among transgender women of color, specifically sexual risk behavior and risky body modification practices. This framework is centered on the concept of gender affirmation, the process by which individuals are affirmed in their gender identity through social interactions. Qualitative data from 22 interviews with transgender women of color from the San Francisco Bay Area in the United States are analyzed and discussed in the context of the gender affirmation framework.
Keywords Transgender identity . Gender affirmation . Stigma . Race . Risk behavior . Sexuality
Introduction
Transgender women, or transwomen, as a group have been found to experience stigmatization and discrimination in multiple arenas of life, in many different countries around the world (Barrientos et al. 2010; Grant et al. 2011; Lombardi et al. 2001a; Nemoto et al. 2011; Silva-
Santisteban et al. 2011; Wilson et al. 2011; Winter 2010). Transwomen are individuals who were assigned male at birth but do not identify as men and instead identify as women, transgender, or other gender identity. Transwomen as a broad category represents a multitude of diverse experiences, and these experiences can vary widely by culture. In this paper, I will be specifically examining reports of and data related to experiences of transwomen in the United States; thus all studies cited are based on U.S. samples unless otherwise noted. In the U.S., poverty, experiences of victimization, discrimination, and extreme health disparities (especially related to HIV rates and clinical outcomes) have all been well-documented among transwomen of color in particular (Clements-Nolle et al. 2001; Herbst et al. 2008; Lombardi et al. 2001a; Sevelius et al. 2010). Similar experiences of marginalization have been documented among transwomen in other countries around the world as well, such as Peru,...