Dyadic dynamics of HIV risk among transgender women and their primary male sexual partners: the role of sexual agreement types and motivations.
Transgender women - individuals assigned a male sex at birth who identify as women, female, or on the male-to-female trans feminine spectrum - are at high-risk of HIV worldwide. Prior research has suggested that transgender women more frequently engage in condomless sex with primary cisgender (i.e., non-transgender) male partners compared with casual or paying partners, and that condomless sex in this context might be motivated by relationship dynamics such as trust and intimacy. The current study examined sexual agreement types and motivations as factors that shape HIV risk behaviors in a community sample of 191 transgender women and their cisgender primary male partners who completed a cross-sectional survey. Overall, 40% of couples had monogamous, 15% open, and 45% discrepant sexual agreements (i.e., partners disagreed on their type of agreement). Actor-partner interdependence models were fit to examine the influence of sexual agreement type and motivations on extra-dyadic HIV risk (i.e., condomless sex with outside partners) and intra-dyadic HIV serodiscordant risk (i.e., condomless sex with serodiscordant primary partners). For male partners, extra-dyadic risk was associated with their own and their partners' sexual agreement motives, and male partners who engaged in extra-dyadic HIV risk had an increased odds of engaging in HIV serodiscordant intra-dyadic risk. Study findings support inclusion of the male partners of transgender women into HIV prevention efforts. Future research is warranted to explore the interpersonal and social contexts of sexual agreement types and motivations in relationships between transgender women and their male partners to develop interventions that meet their unique HIV prevention needs.
a Department of Psychiatry & Human Behavior , Alpert Medical School of Brown University , Providence , RI , USA.
Kristi E
KE
Gamarel
b Department of Epidemiology , Harvard School of Public Health , Boston , MA , USA.|c The Fenway Institute, Fenway Health , Boston , MA , USA.
Sari L
SL
Reisner
d Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA.
Lynae A
LA
Darbes
e Center for Research on Gender and Sexuality , San Francisco State University , San Francisco , CA , USA.
Colleen C
CC
Hoff
d Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA.|e Center for Research on Gender and Sexuality , San Francisco State University , San Francisco , CA , USA.
Deepalika
D
Chakravarty
f Public Health Institute , Oakland , CA , USA.
Toru
T
Nemoto
a Department of Psychiatry & Human Behavior , Alpert Medical School of Brown University , Providence , RI , USA.|g Brown University School of Public Health , Providence , RI.
Don
D
Operario
D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D009042:Motivation; D015995:Prevalence; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners; D012959:Socioeconomic Factors; D063106:Transgender Persons / Q000523:psychology*; D035502:Trust; D055815:Young Adult
HIV; Transgender women; couples; relationships; sexual agreements