Risk for HIV and other Sexually Transmitted Infections in Men who Have Sex with Transgender Women

Background: Men who have sex with transgender women are a potentially high-risk population for HIV and other sexually transmitted infections. Men in this population might not fit traditional understandings of sexual orientation categories, and therefore might elude traditional HIV prevention activities.

Methods: Using audio-computer assisted self-interviews, we administered structured quantitative surveys to n=174 male participants whose primary sex partner is a transgender woman. Men were recruited from the San Francisco Bay area using targeted snowball sampling. We assessed sexual behavior, health status, demographic characteristics, and social psychological factors including relationship satisfaction, condom self-efficacy, stigma, and depression.

Results: The sample was diverse with regard to age (range 18-60, mean=35.6), ethnicity (36% Black, 24% White, 18% Hispanic), education (18% no HS diploma, 38% HS diploma, 42.5% some college or more), and sexual orientation identity (23% identified as straight, 23% gay, 45% bisexual, 9% other). Overall, 19% reported being HIV-positive, 11% had at least one other sexually transmitted infection during the past year, and 8% had been diagnosed with AIDS. In the past 3 months, 40% had unprotected anal or vaginal sex with any partner. Unprotected sex was associated with lower relationship satisfaction (p<.05) and greater depression (p<.05), and was not associated with sociodemographic characteristics or with HIV-, STI-, or AIDS-status.

Conclusions: Interventions are needed to reduce risk for HIV and other sexually transmitted infections among men who have sex with transgender women. Prevention programs that address relationships with transgender women and depression among men are warranted.