Background : Hazardous alcohol consumption (HA) is linked to multiple health problems and is the fourth leading lifestyle-related cause of death in the US. Although studies have examined correlates of HA for the general adult population, few studies have explored the demographic and behavioral factors associated with hazardous alcohol use among trans women, highlighting a significant research gap.
Methods : This study evaluated baseline data from the Trans*National cohort study, a respondent-driven sampling (RDS) study of trans women (n=629). Participants completed interviews that collected information on demographic characteristics, alcohol/substance use, and behaviors. HA was classified using AUDIT scores with >4 cutoff. HA correlations were evaluated using Fisher’s exact tests and multivariable logistic regression models, controlling for HIV-status, race/ethnicity, and age
Results : HA prevalence was 20% among trans women and was associated with no health insurance and use of methamphetamine, crack, cocaine, downers, ecstasy, and poppers. Among HIV-positive trans women, HA was associated with not being on antiretroviral treatment (ART). In the multivariable regression, HA remained independently associated with no health insurance (aOR=3.2; 95%CI=1.58-7.01]); crack use (aOR=2.97; 95%CI=1.54-5.72); and cocaine use (aOR=1.83; 95%CI=1.03-3.25).
Conclusions : We observed a high prevalence of HA consumption among transwomen, which was associated with use of multiple classes of substances, lack of health insurance, and for trans women living with HIV, lower access to ART. Given the negative consequences of HA, these findings highlight the need to develop alcohol interventions for trans women, to help improve their health outcomes overall.