Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males.
Open accessAbstract
Female-to-male trans masculine adults who have sex with cisgender (non-transgender) males (TMSM) represent an understudied population in relation to HIV/sexually transmitted infection (STI) risk. This study examined the role of syndemic conditions and social gender affirmation processes (living full-time in one's identified gender) in potentiating sexual risk among TMSM adults in Massachusetts, US. Cross-sectional data were restricted to TMSM who reported lifetime sexual behaviour with a cisgender male (n = 173; mean age = 29.4, SD = 9.6; 18.5% people of colour; 93.1% non-heterosexual identity; 56.1% hormones/surgery). Sexual risk outcomes were: lifetime STI diagnoses, three or more sexual partners in the previous six months, and condomless anal/vaginal sex at last encounter with a cisgender male. Age- and survey mode-adjusted logistic regression models regressed sexual risk outcomes on the main effect of syndemics (six indicators summed: binge drinking, substance use, depression, anxiety, childhood abuse, intimate partner violence), followed by the interaction of syndemics and social gender affirmation. Syndemics were associated with increased odds of all sexual risk indicators (adjusted odds ratios [aORs] = 1.32-1.55; p < 0.0001). Social gender affirmation moderated the association between syndemics and condomless anal/vaginal sex at last encounter with a cisgender male (p < 0.0001). Syndemics were associated with sexual risk in TMSM who had socially affirmed their gender (aOR = 1.79; 95% CI = 1.42-2.25; p < 0.001), but not among those TMSM who had not (aOR = 0.86; 95% CI = 0.63-1.19; p = 0.37). Findings suggest that syndemic pathways to sexual risk are similar for TMSM who have socially gender affirmed as for cisgender MSM. Integration of syndemics and gender affirmation frameworks is recommended in interventions to address TMSM sexual risk.
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Transgender persons often experience high rates of stigma and socioeconomic and structural barriers to care that negatively affect health care usage and increase susceptibility to HIV and STIs.
“Transgender persons often experience high rates of stigma and socioeconomic and structural barriers to care that negatively affect health care usage and increase susceptibility to HIV and STIs (326–332).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [332]
The Introduction describes stigma and rejection experienced by trans masculine people who have sex with cisgender men and links these stressors to HIV/STI-related sexual risk. The Discussion notes that inability to access medical care can prevent a depression diagnosis. The paper does not establish high rates of socioeconomic or structural barriers to care, show that those barriers reduce healthcare use, or extend these findings to transgender persons generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredTransgender men who have sex with cisgender men might be at elevated risk for HIV infection.
“However, transgender men who have sex with cisgender men might be at elevated risk for HIV infection (332,363,364).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [332]
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- Authors
- Reisner, S. L., White Hughto, J. M., Pardee, D., & Sevelius, J.
- Affiliations
- Boston Children's Hospital (US)
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Fenway Health (US)
- University of California, San Francisco (US)
- Corresponding author
- Reisner, Sari L
- Venue
- International Journal of STD & AIDS
- Publisher
- SAGE Publications
- Published
- 2016-07-11
- Volume
- 27
- Issue
- 11
- Pages
- 955-966
- ISSN
- 0956-4624 (ISSN-L)
- 1758-1052
- PMC
- PMC4798921
- OpenAlex
- W2460395779
- Cited by
- 104
- References
- 35
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 9 · 2023: 9 · 2022: 9 · 2021: 10 · 2020: 13 · 2019: 11 · 2018: 8 · 2017: 10 · 2016: 7
- FWCI
- 13.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of STD & AIDS (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH094323, T32MH020031, P30MH062246, P30MH062294)
- Topics
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- syndemic, gender affirmation, sexually transmitted infections, unprotected sex, substance use, anxiety and depression, childhood abuse, intimate partner violence, binge drinking, sexual risk behavior
- MeSH terms
- Adolescent, Adult, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Risk Factors, Risk-Taking, Sexual Partners, Socioeconomic Factors, Transsexualism, HIV Infections, Prevalence, Homosexuality, Male, Unsafe Sex, Young Adult, Transgender Persons
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