Abstract
This dissertation examined the continuing HIV epidemic among transgender women despite overall national declining HIV rates. Specifically, the study sought to test a new biopsychosocial framework, based in Syndemic Theory and the Minority Stress Model, to conceptualize the complexities driving HIV acquisition and transmission risk among transgender women. The framework posited that, due to marginalization, interrelated psychosocial and structural problems, along with unique stressors due to gender, compound to drive biobehavioral HIV risk. A sample of mixed serostatus transgender women (N=81) completed a cross-sectional biopsychosocial assessment. A series of generalized linear regressions were utilized to examine the association between number of syndemic conditions experienced (mental health issues, substance use, intimate partner violence, childhood abuse, economic marginalization, incarceration, gender minority stress) and biobehavioral HIV risk (condomless sex acts, sex work, and needle sharing [not protected by PrEP or viral suppression], and rectal inflammation). Findings support the proposed framework. Specifically, there was high prevalence of, and interrelation between, syndemic conditions. Experiencing higher amounts of syndemic conditions was associated with condomless sex and sex work, but not needle sharing or rectal inflammation. The dissertation concludes with a discussion of how the framework can guide multi-level interventions to mitigate the HIV epidemic among transgender women.