# 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 disadvantages like poverty and incarceration compared to those with trans female partners.

## Contribution

This study is the first to compare HIV risk factors among trans women based on the gender of their sexual partners, highlighting structural inequalities.

## Key findings

- Trans women with cisgender men partners had higher rates of HIV, unstable housing, and incarceration.
- Partnerships with cisgender men were associated with more condomless sex and sex exchange partners.
- Racial/ethnic minority trans women exclusively partnered with cisgender men, indicating structural disparities.

## Abstract

Little is known about differences in HIV risk for trans women by partner gender, particularly with respect to social determinants of health and partner-level factors that affect behavior. We examined differences in demographic, social determinants, and HIV-related risk behaviors for trans women with cisgender 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 via videoconference during shelter-in-place ordinances due to the Covid-19 pandemic. This analysis characterized associations between HIV risk and preventive behaviors comparing trans women with cisgender men partners to trans women with trans women partners.

A total of 336 sexual partners were identified from 156 trans women. Trans women with cisgender men partners were significantly more likely to be from racial/ethnic minority populations and all Black/African American and Latina trans women participants had cisgender men partners only. Trans women with cisgender 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, and HIV 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 cisgender men partners faced, namely structural racism that may explain barriers to education and employment, along with incarceration and recidivism. Interventions focused on economic stability, workforce development and post incarceration re-entry housing and employment support for trans women and their cisgender men partners may have the most impact on reducing HIV risk and incidence.