Relationship Context for HIV Risk among Transgender Women and their Long-term Male Partners

Background: Meta-analytic findings indicate 27% of transgender women in the US are infected with HIV. Other research suggests most HIV-positive transgender women were exposed through sex with long-term male partners. This study aimed to identify and understand HIV risk factors in this relationship context of transgender women and their male partners.

Methods: We conducted in-depth individual interviews with 26 couples (n=52), in which one partner was a transgender woman and the other was male. Interviews focused on relationship dynamics including communication, intimacy, commitment, and support. Using grounded theory method, we examined transcribed interviews, identified emergent themes, and developed a coding scheme.

Results: Qualitative analysis revealed: (a) High risk sexual behaviors within this relationship context varies depending on relationship length, relationship stability, and sociodemographic characteristics of partners; (b) Despite being in a committed relationship, many transgender women engage in sex work for earned income; (c) Male partners reported outside sex partners, including other transgender women and sex workers; (d) Small sexual networks and overlapping sex partners in the community facilitate HIV transmission; (e) Partners revealed inconsistencies and disagreements about sex outside the relationship; (f) Partners described stigma as a challenge to their relationship—i.e., lack of social support, harassment from strangers.

Conclusions: This is the first known study of HIV risk among transgender women and their long-term male partners. Sexual networks, stigma, communication dynamics, and relationship support contribute to risk behavior. Couples-focused interventions might be an effective means for reducing HIV-related sexual risk behaviors and substance use for these individuals.