Sexual Risk Taking Among Transgender Male-to-Female Youths With Different Partner Types

摘要

Objectives. We examined associations between partner types (categorized as main, casual, or commercial) and sexual risk behaviors of sexually active male-to-female (transgender female) youths. Methods . We interviewed 120 transgender female youths aged 15 to 24 years recruited from clinics, community-based agencies, club and bar venues, referrals, and the streets of Los Angeles, California, and Chicago, Illinois. Results. Sexual risk behaviors varied by partner type. Transgender female youths were less likely to use condoms during receptive anal intercourse with their main partner and were less likely to use condoms with a main partner while under the influence of substances. Youth participants were also more likely to talk to a main partner about their HIV status. Our data identified no demographic or social factors that predicted condom use during receptive anal intercourse by partner type. Conclusions . Research and interventions that focus on understanding and mitigating risk behaviors by partner type, especially those that tackle the unique risks incurred with main partners, may make important contributions to risk reduction among transgender female youths. Transgender female youths (young persons born anatomically male who identify as female) are a group at high risk for HIV infection. A growing body of research shows estimates of HIV seroprevalence among transgender women that are higher than among other US at-risk populations. 1 – 4 A meta-analysis of the HIV prevention literature focused on transgender women found that 27.7% of transgender women tested positive for HIV, while 11.8% reported being HIV positive. 5 In the 2 studies to date, rates of HIV infection among transgender female youths were found to be comparable to those of transgender women. 6 , 7 Some studies have shown that partner type (categorized as main, casual, or commercial) influences the sexual risk behaviors of groups at high risk for HIV infection. 8 – 10 Partnership characteristics have been found to be important predictors of unprotected intercourse. 11 , 12 Research with transgender women and youths has primarily focused on risks associated with commercial sex partners because of the high prevalence of sex work within this community, estimated to range from 24% to 75%. 5 , 6 However, research points to a need to understand the behaviors of transgender female youths with their main partners as well. Studies have shown that men who have sex with men are more likely to have unprotected intercourse with main partners than with casual partners, 9 , 10 and this may also be true for transgender female youths. One study of partner differences among transgender women of color in San Francisco found that significantly more transgender women had recently engaged in unprotected receptive anal intercourse with main partners than with casual or commercial sex partners. 13 This finding is supported by other descriptive studies that found that transgender women reported being less likely to use condoms with their main partners than with their commercial partners. 2 , 14 The need for intimacy with a main partner has been reported by transgender and other women as a reason for lower condom use with main partners. 14 , 15 Research with heterosexual Black and Hispanic women has found that low risk perception within monogamous relationships, misinformation regarding HIV transmission and risky partners, stigma about condom use, and lower self-efficacy for condom use are common reasons for unsafe sex with steady partners. 16 The most recent hypotheses about why high-risk individuals may be having more unprotected sex in steady relationships involve serosorting. Serosorting has been defined as “ the practice of preferentially having sex with partners of concordant HIV status or of selectively using condoms with HIV-discordant partners.” 12 (p212) Increases in serosorting have been observed among men who have sex with men, but no data exist on whether this phenomenon occurs among transgender female youths. 17 Despite the growing literature on transgender women and other high-risk groups, data are needed concerning the influence of partner types on the sexual risk behaviors of transgender female youths. We examined associations between partner types and sexual risk behaviors among sexually active transgender female youths from Chicago, Illinois, and Los Angeles, California. Most participants in our study were ethnic minority transgender female youths who identified as something other than White. We hypothesized that transgender female youths would engage in riskier sexual behaviors with main partners than with casual and commercial partners because studies of other high-risk populations suggest that main partnerships may carry the highest risk for HIV transmission.