“There's No Pamphlet for the Kind of Sex I Have”: HIV-Related Risk Factors and Protective Behaviors Among Transgender Men Who Have Sex With Nontransgender Men

Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA.
The Journal of the Association of Nurses in AIDS Care: JANAC (Impact Factor: 1.27). 09/2009; 20(5):398-410. DOI: 10.1016/j.jana.2009.06.001
Source: PubMed


Preliminary evidence has suggested that some transgender men who have sex with nontransgender men ("trans MSM") may be at risk for HIV and sexually transmitted infections and that their prevention needs are not being met. Quantitative (n =45) and qualitative (n =15) interviews explored risk behaviors, protective strategies, and perceptions of the impact of transgender identity on sexual decision making among trans MSM. A majority of the participants reported inconsistent condom use during receptive vaginal and anal sex with nontrans male partners; HIV prevalence was 2.2%. Risk factors included barriers to sexual negotiation such as unequal power dynamics, low self-esteem, and need for gender identity affirmation. Protective strategies included meeting and negotiating with potential partners online. Results of this study provide initial evidence that current risk behaviors could lead to rising HIV prevalence rates among trans MSM. Prevention programs must tailor services to include issues unique to trans MSM and their nontrans male partners.

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Available from: Jae M Sevelius, Mar 14, 2014
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    • "Prior research with adult MTF adult women suggests that sexual risk may be most likely with sexual partners who affirm their gender, particularly in the context of a primary male partner (Bockting, Robinson, & Rosser, 1998; Melendez & Pinto, 2007; Nemoto, Operario, Keatley, & Villegas, 2004; Operario et al., 2011). Gender affirmation has also been shown to be an important determinant of adult FTM adult men's sexual health including sexual risk behaviors with non-transgender MSM (Reisner, Perkovich, & Mimiaga, 2010; Sevelius, 2009). Given the chart review nature of this study, it was not possible to measure gender affirmation processes, which represents a limitation of this research and direction for future study. "
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    ABSTRACT: The sexual health of transgender adolescents and young adults who present for health care in urban community health centers is understudied. A retrospective review of electronic health record (EHR) data was conducted from 180 transgender patients aged 12-29 years seen for one or more health-care visits between 2001 and 2010 at an urban community health center serving youth in Boston, MA. Analyses were restricted to 145 sexually active transgender youth (87.3% of the sample). Laboratory-confirmed HIV and sexually transmitted infections (STIs) seroprevalence, demographics, sexual risk behavior, and structural and psychosocial risk indicators were extracted from the EHR. Analyses were descriptively focused for HIV and STIs. Stratified multivariable logistic regression models were fit for male-to-female (MTF) and female-to-male (FTM) patients separately to examine factors associated with any unprotected anal and/or vaginal sex (UAVS). The mean age was 20.0 (SD = 2.9); 21.7% people of color, 46.9% white (non-Hispanic), 21.4% race/ethnicity unknown; 43.4% MTF, and 56.6% FTM; and 68.3% were on cross-sex hormones. Prevalence of STIs: 4.8% HIV, 2.8% herpes simplex virus, 2.8% syphilis, 2.1% chlamydia, 2.1% gonorrhea, 2.8% hepatitis C, 1.4% human papilloma virus. Only gonorrhea prevalence significantly differed by gender identity (MTF 2.1% vs. 0.0% FTM; p = 0.046). Nearly half (47.6%) of the sample engaged in UAVS (52.4% MTF, 43.9% FTM, p = 0.311). FTM more frequently had a primary sex partner compared to MTF (48.8% vs. 25.4%; p = 0.004); MTF more frequently had a casual sex partner than FTM (69.8% vs. 42.7% p = 0.001). In multivariable models, MTF youth who were younger in age, white non-Hispanic, and reported a primary sex partner had increased odds of UAVS; whereas, FTM youth reporting a casual sex partner and current alcohol use had increased odds of UAVS (all p < 0.05). Factors associated with sexual risk differ for MTF and FTM youth. Partner type appears pivotal to understanding sexual risk in transgender adolescents and young adults. HIV and STI prevention efforts, including early intervention efforts, are needed in community-based settings serving transgender youth that attend to sex-specific (biological) and gender-related (social) pathways.
    Full-text · Article · Mar 2015 · AIDS Care
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    • "Similarly, 60% reported receptive anal sex in the past 12 months with 40% " always " using condoms. Although only 2% of this sample was HIVinfected , nearly half (47%) had been diagnosed with an STD at some time in the past (24% HPV, 11% Chlamydia, 11% herpes, 9% bacterial vaginosis, 7% gonorrhea, and 7% trichomoniasis) (Sevelius, 2009). While HIV prevalence among FTMs may be currently low relative to MTFs and nontransgender men who have sex with men (MSM), it appears there may be a subgroup of FTMs engaging in sexual risk behaviors that could lead to a rise in HIV and STD incidence in this community. "
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    ABSTRACT: The sexual health of female-to-male (FTM) transgender men remains understudied. De-identified electronic medical records of 23 FTMs (mean age = 32, 48% racial/ethnic minority) who screened for sexually transmitted diseases (STDs) between July and December 2007 at a Boston, Massachusetts area health center were analyzed. Almost half (48%) were on testosterone and 39% had undergone chest surgery; none had undergone genital reconstruction. The majority (57%) were bisexual, and 30% reported sex with nontransgender males only in the prior three months. One individual was HIV-infected (4.3%) and two (8.7%) had a history of STDs (all laboratory-confirmed). Overall, 26% engaged in sexual risk behavior in the prior three months (i.e., unprotected sex with a nontransgender male, condom breakage, or anonymous sex). The majority (61%) had a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) diagnosis (52% depression, 52% anxiety, and 26% adjustment disorder), and regular alcohol use was common (65%). Alcohol use, psychosocial distress histories, and sex with males only (versus with males and females) were associated with sexual risk in the past three months. Transgender men have concomitant psychosocial health vulnerabilities which may contribute to sexual risk behaviors. Future research is needed to understand the myriad social, behavioral, and biological factors that contribute to HIV and STD vulnerability for FTMs.
    Full-text · Article · Nov 2013 · AIDS Care
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    • "Previously reported demographic estimates from Trans PULSE are similar to Ontario population estimates, highlighting the strength of our RDS method in reaching a broad sample of trans people across Ontario (Bauer et al., 2012). In comparison to smaller studies that have explicitly recruited sexually active gay, bisexual, or queer-identified trans men in urban centers (Myers et al., 2007; Reisner et al., 2010; Sevelius, 2009), this sample may better reflect the diversity of trans GB-MSM in urban, suburban , and rural areas in Canada's most populous province. It is important to note that while RDS has been demonstrated to produce statistically unbiased estimates (Salganik, 2006), CI are wide. "
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    ABSTRACT: Recent reports have addressed the sexual health of female-to-male transgender or transsexual people who are gay, bisexual, and/or have sex with men (trans GB-MSM) using urban convenience samples. The Trans PULSE Project conducted a multimode, respondent-driven sampling survey in Ontario, Canada, in 2009-2010. Weighted estimates were calculated for trans GB-MSM (n = 173) for sexual orientation, behavior, partners, and HIV-related risk, as well as for psychosocial stressors and sexual satisfaction. An estimated 63.3% (95% CI [50.4, 73.5]) of trans men were GB-MSM (173/227). Results indicate great diversity in sexual behavior and experiences. Implications for sexual health promotion, counseling, and medical care are addressed.
    Full-text · Article · Apr 2013 · International Journal of Transgenderism
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