HIV This Week

Risk for HIV and unprotected sexual behaviour in male primary partners of transgender women

Operario D, Nemoto T, Iwamoto M, Moore T. Arch Sex Behav. 2011 May 21.

Men who have sex with transgender women are a potentially high-risk population for HIV and other sexually transmitted infections. Operario and colleagues administered structured quantitative surveys to 174 men whose primary partner was a transgender woman. They assessed men's demographic characteristics, sexual behaviours, substance use, and social-psychological factors, including condom use self-efficacy and depression. Overall, 19% reported being HIV-positive (8% had been diagnosed with AIDS), 11% had at least one other sexually transmitted infection during the past year, and 16% reported being in a HIV serodiscordant relationship with their primary partner. In the past 3 months, 40% had unprotected anal or vaginal sex with any partner. In multivariate analysis, significant correlates of having unprotected sex included younger age, concurrent partnerships, alcohol intoxication, and low condom use self-efficacy; depression was marginally associated with having unprotected sex. Interventions are needed to reduce risk for HIV and other sexually transmitted infections among men who have sex with transgender women. Prevention programmes for these men should build condom use self-efficacy and address the contributions of alcohol intoxication, concurrent sex partnerships, and depression to sexual risk behaviour.

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Editor’s note: A study of men in primary relationships with transgender women is very rare. Being in a ‘primary relationship’ was defined as two adults committed to each other above anyone else. The couples were identified through snowball referral techniques (Do you know couples like yours that could be interested in the study? Could you refer them to us?) and through direct approaches to couples in bars, nightclubs, book stores, community based organisations, health clinics, parks, and street locations where study advertisements were posted. The average relationship duration was 2.9 years and 47% of the couples in this convenience sample lived together. This paper describes the male partners¾they reported being bisexual (45%), homosexual (23%), heterosexual (23%), and other or not willing to categorise themselves (9%). Men whose primary partner was post-operative were more likely than those with a pre-operative transgender partner to identify as heterosexual (53% vs. 20%). Overall 58% of the men in this San Francisco Bay area study described the relationship as monogamous, however one in five of them, and 12% of their transgender partners, had sex with an outside partner during the current primary partnership. Whether or not these couples are serodiscordant (one in six are), couples-based interventions aimed at strengthening safer sex practices are warranted, without preconceived assumptions about the sexual orientation of the men.