title: Unprotected sexual behavior and HIV risk in the context of primary partnerships for transgender women.
abstract: Previous research has reported that transgender women are likely to be exposed to HIV through unprotected sex with a male primary partner. We examined prevalence and correlates of unprotected sex with a primary male partner in a sample of n = 174 transgender women. Participants completed surveys on demographic characteristics, relationship dynamics with their male primary partner, sexual behavior, substance use, and psychosocial factors. Overall, 41% reported HIV positive status, 13% had another sexually transmitted infection during the past year, and 34% had unprotected sex with a male primary partner during the past 3 months. Factors associated with unprotected sex with a primary partner included living with the partner, drug use, alcohol use, education level, low self-efficacy to use condoms, and perceived discrimination. Notably, 35% of transgender women in HIV-discordant primary partnerships had unprotected sex with their male primary partner during the past 3 months, and 18% of transgender women in HIV-positive concordant primary partnerships had unprotected sex with an outside partner during the past 3 months. HIV prevention interventions for transgender women must address risk behavior in the context of primary partnerships as well as sex with concurrent partners outside the relationship. Couples-focused interventions involving transgender women and their male primary partners can be particularly promising.
authors.affiliation: Department of Community Health, Brown University, Providence, Rhode Island, USA. Don_Operario@brown.edu
authors.forename: Don
authors.initials: D
authors.lastname: Operario
authors.forename: Tooru
authors.initials: T
authors.lastname: Nemoto
authors.forename: Mariko
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Toni
authors.initials: T
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012495:San Francisco / Q000453:epidemiology; D012747:Sexual Partners; D012959:Socioeconomic Factors; D014189:Transsexualism; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult