Practices of receptive and insertive anal sex among transgender women in relation to partner types, sociocultural factors, and background variables

Abstract

It is urgent to develop efficacious HIV prevention programs to curb the reported extremely high HIV prevalence and incidence among transgender women (male-to-female transgender persons) who reside in large cities in the USA. This study aimed to describe unprotected receptive anal sex (URAS) and unprotected insertive anal sex (UIAS) among high-risk transgender women in relation to partner types, psychosocial factors, and background variables. Based on purposive sampling from the targeted communities and AIDS service organizations in San Francisco and Oakland, a total of 573 transgender women who had a history of sex work were recruited and individually interviewed using a structured survey questionnaire. Significant correlates with URAS with primary, casual, and commercial sex partners were found (e.g., needs for social support, frequency of social support received, exposure to transphobia, self-esteem, economic pressure, norms toward practicing healthy behaviors, and self-efficacy toward practicing safe sex). Multiple logistic regression analyses revealed that transgender women who had engaged in URAS with commercial partners were more likely to have higher levels of transphobia or lower levels of the norms or self-efficacy to practice safe sex. Among the participants who did not have vaginoplasty (preoperative transgender women), 16.4% had engaged in insertive anal sex (IAS) with commercial partners in the past 30 days. The participants who were HIV positive and had engaged in IAS were more likely to be African-American or Caucasians, coinfected with sexually transmitted infections, or identified themselves as homosexual. Practices of IAS among transgender women have not been thoroughly investigated in relation to sexual and gender identity. UIAS with homosexual and bisexual men in addition to URAS may be a cause for high HIV incidence among transgender women. An HIV prevention intervention study must be developed and evaluated, which aims to reduce HIV-positive and -negative transgender women's URAS and UIAS.

Keywords:

• transgender
• HIV risk
• sociocultural factor
• unprotected anal sex

Acknowledgments

The authors thank collaborating community-based agencies, project staff, and study participants for their help in developing and implementing the study and their dedication to improving health and well-being for transgender people and promoting their human rights. This study was supported by the National Institute on Drug Abuse (NIDA) (Grant No.: R01 DA11589; Principal Investigator: Tooru Nemoto). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIDA, National Institute of Health. This study was approved by the Committee on Human Research, University of California San Francisco. Sample participant consent forms are available upon request.