Structural disadvantage and HIV risk – comparing risk factors between trans women’s partnerships with cis men and trans women sexual partners

TL;DR

Trans women with cisgender male partners face higher HIV risk due to shared social and economic challenges like unstable housing and incarceration.

Contribution

This study compares HIV risk factors between trans women's partnerships with cis men and trans women, highlighting structural disadvantages.

Findings

Trans women with cis men partners had lower education, employment, and higher incarceration rates compared to those with trans women partners.

Trans women with cis men partners reported more HIV infections and condomless sex, especially under substance use.

Shared experiences of housing instability and incarceration among trans women and their cisgender male partners contribute to higher HIV risk.

Abstract

Little is known about differences in HIV risk for trans women by partner gender, particularly with respect to social determinants and partner-level circumstances that affect behavior. We examined differences in demographic, social determinants, and HIV-related risk behaviors for trans women with cis men and trans women sexual partners.

Data are from a cross-sectional survey of trans women and their sexual partners conducted between April 2020 and January 2021. Interviews were held remotely during shelter-in-place due to Covid-19 via videoconference. Analysis characterizedassociations between HIV risk and protective behaviors comparing trans women with cisgender men partners to trans women with non-cisgender sexual partners.

A total of 336 sexual partners were identified from 156 trans women. Trans women with cis men partners had significantly less education and employment and more incarceration and recidivism than trans women with trans women partners. Trans women and their cisgender men partners had shared experiences of unstable housing, incarceration, and HIV. Trans women with cisgender men partners reported significantly more sex exchange partners, receptive condomless sex, receptive or insertive condomless sex while using substances, and HIV infection compared to trans women with trans women partners.

Trans women with cisgender men sexual partners faced higher HIV risk than trans women with trans women sexual partners. These risks may be related to the social and economic drivers that both trans women and their cis men partners faced, including barriers to education and employment, along with incarceration and recidivism. Interventions focused on economic stability, workforce development and post incarceration re-entry support for housing and employment for trans women with cis men partners and the cisgender men partners as well may have the most impact on reducing HIV risk and incidence.