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Lifetime Risk Factors for HIV/Sexually Transmitted Infections Among Male-to-Female Transgender Persons

Nuttbrock, Larry PhD*; Hwahng, Sel PhD*; Bockting, Walter PhD; Rosenblum, Andrew PhD*; Mason, Mona; Macri, Monica MPH; Becker, Jeffrey MPH, MSW

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 2009 - Volume 52 - Issue 3 - p 417-421
doi: 10.1097/QAI.0b013e3181ab6ed8
Brief Report: Epidemiology and Social Science

Objectives: To describe and evaluate risk factors for HIV/sexually transmitted infections (STIs) among male-to-female (MTF) transgender persons.

Methods: Using the life chart interview, potential lifetime risk factors for HIV/STIs among MTFs were measured and evaluated in conjunction with lifetime exposures for HIV, syphilis, hepatitis B, and hepatitis C. The participants were 517 MTFs between the ages of 19 and 59 years from the New York metropolitan area.

Results: HIV/STIs were low among white Americans and very high among Hispanics and African Americans. In the latter groups, HIV and hepatitis B were associated with an androphilic sexual orientation, lifetime number of commercial sex partners (sex work), and the social expression of transgender identity; syphilis was associated with lifetime number of casual sex partners; and hepatitis C was associated with injection drug use, unemployment, and social expression of transgender identity. In multivariate models, the social expression of transgender identity was the strongest and most consistent predictor of HIV/STIs. Consistent with their lower levels of infections, white Americans reported significantly lower levels of the risk factors found to be predictive of HIV/STI among Hispanics and African Americans.

Conclusions: HIV/STI prevention in this population should be targeted at Hispanic and African Americans. Prevention programs should incorporate multiple components designed to address the diverse issues confronting ethnic minority transgender persons, with an emphasis on the social expression of transgender identity.

From the *National Development and Research Institutes, New York, NY; and †Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN.

Received for publication November 14, 2008; accepted March 6, 2009.

Supported by a grant from the National Institute of Drug Abuse (1 R01 DA018080) (L.N., principal investigator) and by a National Institute of Drug Abuse administrative research supplement to promote diversity in health related research (S.H., Investigator).

Correspondence to: Larry Nuttbrock, PhD, National Development and Research Institutes, 71 W, 23rd St, 8th Floor, New York, NY 10010 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.