Men Who Have Sex with Transgender Women: Challenges to Category-based HIV Prevention

Abstract

Although transgender women are acknowledged as a priority population for HIV prevention, there is little knowledge on men who have sex with transgender women (MSTGWs). MSTGWs challenge conventional sexual orientation categories in public health and HIV prevention research, and warrant increased attention from the public health community. This paper used qualitative techniques to analyze how MSTGWs describe their sexual orientation identities, and to explore the correspondence between men’s identities and sexual behaviors with transgender women. We conducted in-depth semi-structured individual interviews with 46 MSTGWs in San Francisco. We observed a diversity in the ways participants identified and explained their sexual orientation, and found no consistent patterns between how men described their sexual orientation identity versus their sexual behavior and attraction to transgender women. Findings from this qualitative study question the utility of category-based approaches to HIV prevention with MSTGWs and offer insights into developing HIV interventions for these men.

This is a preview of subscription content, log in to check access.

References

  1. Beyrer, C., Sripaipan, T., Tovanabutra, S., Jittiwutikarn, J., Suriyanon, V., Vongchak, T., Srirak, N., Kawichai, S., Razak, M. H., & Celentano, D. D. (2005). High HIV, hepatitis C and sexual risks among drug-using men who have sex with men in northern Thailand. AIDS, 19, 1535–1540.

    Article  PubMed  Google Scholar 

  2. Blanchard, R., & Collins, P. I. (1993). Men with sexual interest in transvestites, transsexuals, and she-males. Journal of Nervous and Mental Disease, 181, 570–575.

    Article  CAS  PubMed  Google Scholar 

  3. Boehmer, U. (2002). Twenty years of public health research: Inclusion of lesbian, gay, bisexual, and transgender populations. American Journal of Public Health, 92, 1125–1130.

    PubMed  Google Scholar 

  4. Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001). HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health, 91, 915–921.

    CAS  PubMed  Google Scholar 

  5. El-Bassel, N., Witte, S. S., Gilbert, L., Wu, E., Chang, M., Hill, J., & Steinglass, P. (2005). Long-term effects of an HIV/STI sexual risk reduction intervention for heterosexual couples. AIDS and Behavior, 9, 1–13.

    Article  PubMed  Google Scholar 

  6. Elifson, K. W., Boles, J., Posey, E., Sweat, M., Darrow, W., & Elsea, W. (1993). Male transvestite prostitutes and HIV risk. American Journal of Public Health, 83, 260–262.

    CAS  PubMed  Google Scholar 

  7. Farquhar, C., Kiarie, J. N., Ricardson, B. A., Kabura, M. N., John, F. N., Nduati, R. W., Mbori-Ngacha, D. A., & John-Stewart, G. C. (2004). Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. Journal of Acquired Immune Deficiency Syndromes, 37, 1620–1626.

    Article  PubMed  Google Scholar 

  8. Ford, C. L., Whetten, K. D., Hall, S. A., Kaufman, J. S., & Thrasher, A. D. (2007). Black sexuality, social construction, and research targeting ‘The Down Low’ (‘The DL’). Annals of Epidemiology, 17, 209–216.

    Article  PubMed  Google Scholar 

  9. Hernandez, A. L., Lindan, C. P., Mathur, M., Ekstrand, M., Madhivanan, P., Stein, E. S., Gregorich, S., Kundu, S., Gogate, A, & Jerajani, H. R. (2006). Sexual behavior among men who have sex with women, men, and Hijras in Mumbai, India-multiple sexual risks. AIDS and Behavior, 10(Suppl), S5–16.

    Article  PubMed  Google Scholar 

  10. Huxley, P. J., Kenna, J. C., & Brandon, S. B. (1981). Partnership in transsexualism. Part ii. The nature of the partnership. Archives of Sexual Behavior, 10, 143–160.

    Article  CAS  PubMed  Google Scholar 

  11. Israel, G., & Tarver, D. (1998). Transgender care: Recommended guidelines, practical information, and personal accounts. Philadelphia, PA: Temple University Press.

    Google Scholar 

  12. Kellogg, T. A., Clements-Nolle, K., Dilley, J., Katz, M. H., & McFarland W. (2001). Incidence of human immondeficiency virus among male-to-female transgendered persons in San Francisco. Journal Acquired Immune Deficiency Syndromes, 28, 380–384.

    CAS  Google Scholar 

  13. Lansky, A., Sullivan, P. S., Gallagher, K. M., & Fleming, P. L. (2007). HIV behavioral surveillance in the U.S.: A conceptual framework. Public Health Reports, 122(Suppl. 1), 16–23.

    PubMed  Google Scholar 

  14. Modan, B., Goldschmidt, R., Rubinstein, E., Vonsover, A., Zinn, M., Golan, R., Chetrit, A., & Gottlieb-Stematzky, T. (1992). Prevalence of HIV antibodies in transsexual and female prostitutes. American Journal of Public Health, 82, 590–592.

    CAS  PubMed  Article  Google Scholar 

  15. Money, J., & Lamacz, M. (1984). Gynemimesis and gynemimetophilia: Individual and cross-cultural manifestations of a gender-coping strategy hitherto unnamed. Comprehensive Psychiatry, 25, 392–403.

    Article  CAS  PubMed  Google Scholar 

  16. Nemoto, T., Operario, D., Keatley, J., Han, L., & Soma, T. (2004). HIV risk behaviors among male-to-female transgneder persons of color in San Francisco. American Journal of Public Health, 94, 1193–1199.

    PubMed  Google Scholar 

  17. Pathela, P., Hajat, A., Schillinger, J., Blank, S., Sell, R., & Mostashari, F. (2006). Discordance between sexual behaviour and self-reported sexual identity: A population-based survey of New York City men. Annals of Internal Medicine, 19, 416–425.

    Google Scholar 

  18. Pisani, E., Girault, P., Gultom, M., Sukartini, N., Kumalawati, J., Jazan, S., & Donegan, E. (2004). HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia. Sexually Transmitted Infections, 80, 536–540.

    Article  CAS  PubMed  Google Scholar 

  19. Plummer, K. (1995). Telling sexual stories: Power, change, and social worlds. London: Routledge.

    Google Scholar 

  20. Remien, R. H., Stirratt, M. J., Dolezal, C., Dognin, J. S., Wagner, G. J., Carballo-Dieguez, A., El-Bassel, N., & Jung, T. M. (2005). Couple-focused support to improve HIV medication adherence: A randomized controlled trial. AIDS, 19, 807–814.

    Article  PubMed  Google Scholar 

  21. Schrock, D. P., & Reid, L. L. (2006). Transsexuals’ sexual stories. Archives of Sexual Behavior, 35, 75–86.

    Article  PubMed  Google Scholar 

  22. Spizzichino, L., Zaccarelli, M., Rezza, G., Ippolito, G., Antinori, A., & Gattari P. (2001). HIV infection among foreign transsexual sex workers in Rome: Prevalence, behavior patterns, and seroconversion rates. Sexually Transmitted Diseases, 28, 405–411.

    Article  CAS  PubMed  Google Scholar 

  23. Varella, D., Tuason, L., Proffitt, M. R., Escaleira, N., Alquezar, A., & Bukowski, R. M. (1996). HIV infection among Brazilian transvestites in a prison population. AIDS Patient Care and STDs, 10, 299–302.

    CAS  PubMed  Article  Google Scholar 

  24. Wylie, K. (2004). Gender related disorders. BMJ, 329, 615–617.

    Article  PubMed  Google Scholar 

  25. Young, R. M, & Meyer, I. H. (2005). The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American Journal of Public Health, 95, 1144–1149.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Lally Adao and Andrea Horne, and all men who participated in this study. This research was supported by the California HIV/AIDS Research Program (grant ID03-SF-009) and the National Institute on Drug Abuse (grant R01-DA18621).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Don Operario.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Operario, D., Burton, J., Underhill, K. et al. Men Who Have Sex with Transgender Women: Challenges to Category-based HIV Prevention. AIDS Behav 12, 18–26 (2008). https://doi.org/10.1007/s10461-007-9303-y

Download citation

Keywords

  • Men
  • Transgender
  • HIV
  • Sexual orientation
  • Qualitative