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  • Special Section: Social and Behavioral Science with Gay and Bisexual Men in the Era of Biomedical Prevention
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Relationship Stigma and HIV Risk Behavior Among Cisgender Men Partnered with Transgender Women: The Moderating Role of Sexual Identity


Cisgender men partnered with transgender women are an understudied and hard to engage population in HIV prevention efforts. Relationship stigma—the anticipation of negative treatment based on having a relationship with a member of a stigmatized group—has been linked to adverse health behaviors, but it remains unclear whether different sources of relationship stigma (i.e., family, friends, and the general public) are associated with HIV risk behaviors and whether these associations may vary by men’s sexual identities (e.g., gay, bisexual, and heterosexual). The current study examined associations between relationship stigma and HIV risk behaviors and whether these associations were moderated by sexual identity. We recruited a convenience sample of 185 cisgender men in primary partnerships with transgender women to participate in a one-time survey. Gay identified men reported greater levels of relationship stigma from the general public compared with heterosexually identified men. In multivariable models, higher levels of relationship stigma from the public were associated with increased odds of engaging in drug use prior to having condomless sex and receiving an STI diagnosis in the last 30 days. There were significant interaction effects such that higher levels of relationship stigma from the public were associated with both indicators of HIV risk for gay identified men but not for heterosexually identified men. Findings support the importance of HIV prevention approaches accounting for relationship stigma from the general public and the diverse sexual identities of men partnered with transgender women when seeking to increase linkage to and engagement in HIV prevention services, including biomedical prevention strategies.

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This research was supported by grants from the National Institutes of Health (R01DA018621, R34MH093232; R01MH115765). The first author was also supported (in part) by research education grant (R25MH067127). We gratefully thank the men who participated in the study; staff members; and colleagues Mariko Iwamoto and Colleen Hoff for their valuable contributions to this project. We also thank Dr. Susannah Allison for her support of this work.

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Correspondence to Kristi E. Gamarel.

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The authors declare that they have no conflict of interest.

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This research was approved by the Institutional Review Board at the Public Health Institute, Oakland, University of California, San Francisco, and University of Oxford, Oxford, UK. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Gamarel, K.E., Sevelius, J.M., Reisner, S.L. et al. Relationship Stigma and HIV Risk Behavior Among Cisgender Men Partnered with Transgender Women: The Moderating Role of Sexual Identity. Arch Sex Behav 49, 175–184 (2020). https://doi.org/10.1007/s10508-019-1446-1

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  • HIV prevention
  • Stigma
  • Sexual identity
  • Sexual risk behavior
  • Gay men
  • Transgender