High Risk for HIV Transmission among Transgender Women and their Male Partners

Background: Transgender women are among the highest-risk groups for HIV in the United States. HIV-positive transgender women frequently report their steady male partners as source of exposure. This research measured HIV risk behavior among transgender women and men in a committed relationship.

Methods: Forty-six couples were recruited (n=92), where one partner was a transgender woman and one was male. Participants independently completed quantitative ACASI surveys assessing sexual behavior, sociodemographic factors, and relationship factors.

Results: Couples were in a relationship for an average of 2.8 years. Men were more likely to describe their relationship as monogamous; transgender women were more likely to describe their relationship as allowing outside partners. However, more men than women had casual sex partners outside the relationship (p<.05). Only transgender women had commercial sex partners outside the relationship (p<.05). 40% of couples reported unprotected anal sex in the relationship where the transgender woman was the receptive partner; 13% reported unprotected anal sex where the man as the receptive partner. Transgender women were more likely to be HIV-positive (57%) than men (30%). 15% incorrectly diagnosed their partners' HIV status: transgender women were more likely to overestimate their partner being HIV-positive, whereas men were more likely to underestimate their partner being HIV-positive.

Conclusion: We observed high levels of unprotected sex in this relationship context and frequent sex with outside partners. Inconsistencies among partners indicate insufficient communication about HIV status and risk. Interventions are needed to prevent HIV for these couples, within the relationship and with outside partners.