Partnership-level correlates of sexual risk taking within the sexual partnerships of young transwomen in San Francisco, California

Abstract

ObjectivesLittle is known about the sexual networks of young transwomen, leaving a major gap in what we know about transmission dynamics and the elevated rates of HIV in this population. The objective of this study was to understand partnership-level factors associated with condomless anal sex among young transwomen.MethodsA secondary data analysis of the sexual partnerships of young transwomen was conducted using baseline data from the SHINE study. Generalised estimating equation logistic regressions were used to assess for partnership-level associations between partnership type, age, injection drug use and racial concordance, HIV seroconcordance, sexual role and condomless receptive (CRAI) and insertive anal intercourse (CIAI).ResultsOur analysis included 187 young transwomen that reported a total of 464 sexual partnerships where they had at least one episode of anal sex in the past 6 months. We found casual (n=232 or 50%) and commercial partnerships (n=106 or 22.8%) to be significantly associated with a lower odds of CIAI (OR=0.53, 95% CI 0.32 to 0.86 and OR=0.39, 95% CI 0.18 to 0.82) and CRAI (OR=0.30, 95% CI 0.19 to 0.47 and OR=0.35, 95% CI 0.2 to 0.62) compared with main partnerships (n=126 or 27.2%). Additionally, HIV-positive seroconcordant (n=25 or 5.4%, OR=4.05, 95% CI 1.44 to 11.40) and injection-drug using partnerships (n=25 or 5.4%, OR=3.66, 95% CI 1.34 to 9.95) were found to be significantly associated with an increased odds of CIAI among participants compared with HIV-negative seroconcordant (n=330 or 71.1%) and non-using partnerships (n=338 or 72.8%), respectively.ConclusionYoung transwomen, like other populations, engage in condomless sex more often with main than casual and commercial partners, suggesting a need for interventions that address sexual practices with steady main partners.

HIV prevalence, engagement in care, and risk behavior among trans women, San Francisco: Evidence of recent successes and remaining challenges

“…An epidemiological conundrum has been why trans women experience the highest prevalence of HIV when their reported sexual partners, men attracted to women, have the lowest in San Francisco. 15,20,23 We found the single strongest association with HIV positivity was having a partner with a history of injection drug use. This association was independent of their own history of injection drug use, which also remained strongly predictive of HIV infection in multivariable analysis.…”

“…A few studies suggest the risk may originate with main partners, rather than casual or commercial partners. 15 , 16 However, the risk behaviors of partners themselves are largely unknown. Therefore, frequent updates on the current status of the HIV epidemic among trans women are critical to the success in getting to zero HIV infections by 2025.…”