HIV Risk Behaviors in the U.S. Transgender Population: Prevalence and Predictors in a Large Internet Sample

Abstract

To study the influence of gender on HIV risk, a sample of the U.S. transgender population (N = 1,229) was recruited via the Internet. HIV risk and prevalence were lower than reported in prior studies of localized, urban samples but higher than the overall U.S. population. Findings suggest that gender nonconformity alone does not itself result in markedly higher HIV risk. Sex with nontransgender men emerged as the strongest independent predictor of unsafe sex for both male-to-female (MtF) and female-to-male (FtM) participants. These sexual relationships constitute a process that may either affirm or problematize gender identity and sexual orientation, with different emphases for MtFs and FtMs, respectively.

KEYWORDS:

• HIV
• transgender
• United States
• Internet
• gender identity
• unprotected sex
• sexual orientation

We thank Michael Wright, PhD, for assistance with data analysis; Noelle Gray, MPH, and Siv Raman, MBBS, PhD, for assistance with data collection; Heidi Fall for assistance in preparing the article; and the study’s National Transgender Community Advisory Board for their participation and support of the project.