Feature“There's No Pamphlet for the Kind of Sex I Have”: HIV-Related Risk Factors and Protective Behaviors Among Transgender Men Who Have Sex With Nontransgender MenSevelius, Jae, PhDAuthor Information Editors' note:This article contains graphic language and content. JANAC's editorial staff is dedicated to preserving the integrity of the work of all of our authors. In qualitative research, this includes input from participants who are willing to share their experiences with the researcher and—eventually—with the reader. In this article, we have honored those individuals by leaving their words intact. Jae Sevelius, PhD, is Co-Principal Investigator of the Center of Excellence for Transgender HIV Prevention and Assistant Professor, Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco. Journal of the Association of Nurses in AIDS Care: September-October 2009 - Volume 20 - Issue 5 - p 398–410 Buy Abstract Preliminary evidence has suggested that some transgender men who have sex with nontransgender men (“trans MSM”) may be at risk for HIV and sexually transmitted infections and that their prevention needs are not being met. Quantitative (n = 45) and qualitative (n =15) interviews explored risk behaviors, protective strategies, and perceptions of the impact of transgender identity on sexual decision making among trans MSM. A majority of the participants reported inconsistent condom use during receptive vaginal and anal sex with nontrans male partners; HIV prevalence was 2.2%. Risk factors included barriers to sexual negotiation such as unequal power dynamics, low self-esteem, and need for gender identity affirmation. Protective strategies included meeting and negotiating with potential partners online. Results of this study provide initial evidence that current risk behaviors could lead to rising HIV prevalence rates among trans MSM. Prevention programs must tailor services to include issues unique to trans MSM and their nontrans male partners. © 2009Elsevier, Inc.