Dyadic dynamics of HIV risk among transgender women and their primary male sexual partners: the role of sexual agreement types and motivations

Abstract

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.

Keywords:

• Transgender women
• HIV
• sexual agreements
• relationships
• couples

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported by grants from the National Institutes of Health (R01DA018621, R34MH093232, U24AA022000). Dr Gamarel was supported by training grant T32MH 078788. Dr Reisner's time is partly supported by NIMH R34MH104072. This publication was supported (in part) by a developmental grant awarded to PI Dr Reisner (CFAR-FCHC-15-1) by: (1) the Harvard University Center for AIDS Research (CFAR), an NIH funded program (P30 AI060354), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, and OAR; (2) the Harvard Global Health Institute (HGHI).