AIDS and Behavior

, Volume 21, Issue 12, pp 3346–3352 | Cite as

HIV Prevalence, Sexual Partners, Sexual Behavior and HIV Acquisition Risk Among Trans Men, San Francisco, 2014

  • Willi McFarland
  • Erin C. Wilson
  • Henry F. Raymond
Original Paper


We surveyed 122 trans men using a hybrid sampling method that included randomly selected physical and online venues and peer referral to measure HIV prevalence and risk behaviors. HIV prevalence was 0% (one-sided 97.5% confidence interval 0–3.3%). Of 366 partnerships described, 44.8% were with cisgender women, 23.8% with cisgender men, 20.8% with trans men, and 10.7% with trans women. Condomless receptive anal and front hole/vaginal sex averaged one to three episodes per six months. HIV prevalence in trans men is likely closer to heterosexual cisgender men and women in San Francisco than trans women or MSM. Prevention prioritizing trans women and MSM, coupled with individualized and relevant sexual health education for trans men with partners from these populations, may best address the HIV prevention needs of trans men. Systematic collection of transgender status in Census and health data is needed to understand other health disparities among trans men.


Trans men Sexual behavior HIV prevalence 



The views expressed herein do not necessarily reflect the official policies of the City and County of San Francisco; nor does mention of the San Francisco Department of Public Health imply its endorsement.


This study was supported by the National Institutes of Health (R21HD071765 NIH).

Compliance with Ethical Standards

Conflict of interest

All authors declare no conflicts of interest.

Ethical Approval

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 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2014; vol. 26. (2015). Accessed 28 Sept 2016.
  2. 2.
    van Griensven F, van Wijngaarden JWL, Baral S, Grulich A. The global epidemic of HIV infection among men who have sex with men. Curr Opin HIV AIDS. 2009;4(4):300–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22.CrossRefPubMedGoogle Scholar
  4. 4.
    Poteat T, Scheim A, Xavier J, Reisner S, Baral S. Global epidemiology of HIV infection and related syndemics affecting transgender people. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S210–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Santos GM, Wilson EC, Rapues J, Macias O, Packer T, Raymond HF. HIV treatment cascade among transgender women in a San Francisco respondent driven sampling study. Sex Transm Infect. 2014;90(5):430–3.CrossRefPubMedGoogle Scholar
  6. 6.
    Herbst JH, Jacobs ED, Finlayson TJ, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12:1–17.CrossRefPubMedGoogle Scholar
  7. 7.
    Scheim AI, Santos GM, Arreola S, et al. Inequities in access to HIV prevention services for transgender men: results of a global survey of men who have sex with men. J Int AIDS Soc. 2016;19(3 Suppl 2):20779.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Green N, Hoenigl M, Morris S, Little SJ. Risk behavior and sexually transmitted infections among transgender women and men undergoing community-based screening for acute and early HIV infection in San Diego. Medicine. 2015;94(41):e1830.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Stephens SC, Bernstein KT, Philip SS. Male to female and female to male transgender persons have different sexual risk behaviors yet similar rates of STDs and HIV. AIDS Behav. 2011;15(3):683–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Chen S, McFarland W, Raymond HF. Male transgenders in San Francisco: what do we know from HIV test site data? AIDS Behav. 2010;15:569–620.Google Scholar
  11. 11.
    Reisner SL, White JM, Mayer KH, Mimiaga MJ. Sexual risk behaviors and psychosocial health concerns of female-to-male transgender men screening for STDs at an urban community health center. AIDS Care. 2014;26(7):857–64.CrossRefPubMedGoogle Scholar
  12. 12.
    Reisner SL, Hughto JM, Pardee DJ, et al. LifeSkills for Men (LS4 M): pilot evaluation of a gender-affirmative HIV and STI prevention intervention for young adult transgender men who have sex with men. J Urban Health. 2016;93(1):189–205.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Sevelius J. “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 men. J Assoc Nurses AIDS Care. 2009;20:398–410.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bockting W, Huang C-Y, Ding H, Robinson B, Rosser BRS. Are transgender persons at higher risk for HIV than other sexual minorities? A comparison of HIV prevalence and risks. Int J Transgenderism. 2005;8:123–31.CrossRefGoogle Scholar
  15. 15.
    Bockting W, Benner A, Coleman E. Gay and bisexual identity development among female-to-male transsexual in North America: emergence of a transgender sexuality. Arch Sex Behav. 2009;38:688–701.CrossRefPubMedGoogle Scholar
  16. 16.
    Bauer GR, Redman N, Bradley K, Scheim AI. Sexual health of trans men who are gay, bisexual, or who have sex with men: results from Ontario. Canada. Int J Transgenderism. 2013;14:66–74.CrossRefGoogle Scholar
  17. 17.
    Rowniak S, Chesla C, Rose CD, Holzemer WL. Transmen: the risk of gay identity. AIDS Educ Prev. 2011;23:508–20.CrossRefPubMedGoogle Scholar
  18. 18.
    San Francisco Department of Public Health. HIV/AIDS Epidemiology Annual Report 2010 Accessed 28 Sept 2016.
  19. 19.
    Gallagher KM, Sullivan PS, Lansky A, Onorato IM. Behavioral surveillance among people at risk for HIV infection in the U.S.: the national HIV Behavioral Surveillance System. Public Health Rep. 2007;122(Suppl 1):32–8.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Bauer GR, Scheim AI. Sampling bias in transgender studies. Lancet Infect Dis. 2013;13(10):832.CrossRefPubMedGoogle Scholar
  21. 21.
    Reisner SL, Perkovich B, Mimiaga MJ. A mixed methods study of the sexual health needs of New England transmen who have sex with nontransgender men. AIDS Patient Care STDS. 2010;24(8):501–13.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kupper LE, Nussbaum R, Mustanski B. Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals. J Sex Res. 2012;49:244–54.CrossRefGoogle Scholar
  23. 23.
    Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001;91:915–21.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Benotsch EG, Zimmerman RS, Cathers L, et al. Use of the internet to meet sexual partners, sexual risk behavior, and mental health in transgender adults. Arch Sex Behav. 2016;45(3):597–605.CrossRefPubMedGoogle Scholar
  25. 25.
    Lampkin D, Crawley A, Lopez TP, Mejia CM, Yuen W, Levy V. Reaching suburban men who have sex with men for std and hiv services through online social networking outreach: a public health approach. J Acquir Immune Defic Syndr. 2016;72(1):73–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Pinkerton SD, Galletly CL, McAuliffe TL, DiFranceisco W, Raymond HF, Chesson HW. Aggregate versus individual-level sexual behavior assessment: how much detail is needed to accurately estimate HIV/STI risk? Eval Rev. 2010;34(1):19–34.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    San Francisco Department of Public Health. HIV/AIDS Epidemiology Annual Report 2015 Accessed 28 Sept 2016.
  28. 28.
    Wiewel EW, Torian LV, Merchant P, Braunstein SL, Shepard CW. HIV diagnoses and care among transgender persons and comparison with men who have sex with men: New York City, 2006–2011. Am J Public Health. 2016;106(3):497–502.CrossRefPubMedGoogle Scholar
  29. 29.
    Page-Shafer K, Dilley J, McFarland W, et al. Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men. AIDS. 2002;16:2350–2.CrossRefPubMedGoogle Scholar
  30. 30.
    Flores AR, Herman JL, Gates GJ, Brown TNT: How many adults identify as transgender in the united states? Los Angeles, CA: The Williams Institute, June 2016. Accessed 11 Aug 2016.
  31. 31.
    United States Census Bureau.,00 Accessed 28 Sept 2016.
  32. 32.
    Black D, Gates G, Sanders S, Taylor L. Why do gay men live in San Francisco? Accessed 28 Sept 2016.
  33. 33.
    United States Census Bureau. Accessed 28 Sept 2016.
  34. 34.
    Wierckx K, Elaut E, Van Hoorde B, et al. Sexual desire in trans persons: associations with sex reassignment treatment. J Sex Med. 2014;11(1):107–18.CrossRefPubMedGoogle Scholar
  35. 35.
    San Francisco Department of Public Health. HIV/AIDS Epidemiology Annual Report 2010. Accessed 3 Jan 2017.

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Willi McFarland
    • 1
  • Erin C. Wilson
    • 1
  • Henry F. Raymond
    • 1
  1. 1.San Francisco Department of Public HealthSan FranciscoUSA

Personalised recommendations