Differing risk behaviors among MSM, MSM/W and MTF Transgenders at very high risk for HIV infection

BACKGROUND: In Los Angeles County (LAC), 69% of cumulative HIV infections are attributed to male-to-male sexual contact. Examination of risk patterns among associated populations of MSM, MSM/W and male-to-female (MTF) transgenders is warranted.

METHODS: Behavioral risk data were collected among MSM, MSM/W and MTF transgenders enrolled in an HIV risk reduction intervention. A cross-sectional data analysis was conducted to examine sexual and substance use risk behaviors, and explore differences among the study groups.

RESULTS: Unduplicated data from 1,008 participants revealed high HIV prevalence. Among participants, risk factors included high rates of substance use, high risk sexual behavior, and unstable housing. In particular, transgenders engaged in significantly higher rates of sexual exchange encounters yet used condoms more often during receptive anal intercourse, and reported lower substance use, specifically methamphetamine, compared to MSM and MSM/W.

CONCLUSIONS/IMPLICATIONS: Transgender HIV risk behaviors differ from MSM and MSM/W. Transgenders engaged in protective behaviors during high-risk sexual encounters, however, their high number of sexual partners suggests potential for HIV transmission. Interventions for transgenders should emphasize exchange sex practices including reduction of methamphetamine use. Among MSM, high rates of methamphetamine use during sex highlights the significance of substance use associated with HIV transmission. Similarly, high rates of substance use among MSM/W, coupled with unprotected anal intercourse, merit attention as this population may serve as a transmission “bridge” to their female sexual partners. These three at-risk populations represent the core of the HIV epidemic in LAC, therefore, prevention efforts should target the distinct risk patterns within each group.