Risk for HIV and unprotected sexual behavior in male primary partners of transgender women.

Men who have sex with transgender women are a potentially high-risk population for HIV and other sexually transmitted infections (STIs). We administered structured quantitative surveys to 174 men whose primary partner was a transgender woman. We assessed men's demographic characteristics, sexual behaviors, substance use, and social-psychological factors, including condom use self-efficacy and depression. Overall, 19% reported being HIV-positive (8% had been diagnosed with AIDS), 11% had at least one other STI during the past year, and 16% reported being in a HIV serodiscordant relationship with their primary partner. In the past 3 months, 40% had unprotected anal or vaginal sex with any partner. In multivariate analysis, significant correlates of having unprotected sex included younger age, concurrent partnerships, alcohol intoxication, and low condom use self-efficacy; depression was marginally associated with having unprotected sex. Interventions are needed to reduce risk for HIV and other STIs among men who have sex with transgender women. Prevention programs for these men should build condom use self-efficacy and address the contributions of alcohol intoxication, concurrent sex partnerships, and depression to sexual risk behavior.