Transgender women partners form an independent risk group for HIV infection

A study in the capital of Peru, Lima, which was presented at the recent Conference on Retroviruses and Opportunistic Infections (CROI 2019), showed that transgender women's sexual partners are mainly heterosexual polysexual men who rarely have sex with other men. Given this, they should be assigned to a separate risk group in terms of HIV infection.

Worldwide, HIV prevalence among transgender women is significantly higher (about 30%) than among other key groups, in particular gay and bisexual men (12-18%). At the same time, this indicator is less than 0.4% among the heterosexual male population. Available data led epidemiologists to think that transgender women should become infected from men who have sex with other men.

However, a study by a group of scientists from San Francisco presented at IAS 2017 in Paris challenged this view. Specialists used phylogenetic analysis to retrospectively classify partners of transgender women as heterosexual as well as homosexual, and to establish the genetic link of HIV transmitted through sexual contact.

It was found that 47% of transgender women were in a “cluster” or related group of infections with at least one heterosexual man (excluding men who inject drugs), and only 16% were in a group with gay or bisexual men.

Then the experts suggested that the sexual partners of transgender women form a separate, independent, risk group.

Moreover, it was alleged that many transgender women ended up in “clusters” with each other. This, according to scientists, also made it possible to state that the high HIV prevalence among them could be partially due to their belonging to a small, relatively isolated, but closely connected community.

A study in Lima confirmed that partners of transgender women form a separate group, usually of gay and bisexual men. However, among the sexual partners of trans-women, men who had sex with men were a minority, and they were different from other partners.

As Dr. Jessica Long of the University of Washington commented on the results, “transgender women’s partners do not form a single social network.”

Eleven study participants, volunteered (seeds), agreed to “recruit” partners and formed “clusters” ranging in size from four to 250 people. The longest “chain” consisted of eleven people, that is, the last link of the chain was ten sexual contacts from the “source”.

The chart of participants selected for the study clearly showed that most trans women recruited the “first wave” of cisgender men, who, in turn, had contact with the second wave of trans women, and those, in turn, again met the “third wave of cisgender men.

Eleven trans women from the seeds group “recruited” 27 partners, 25 cisgenders, one cisgender woman and one trans woman. Then this “first generation” recruited another 45 partners, of which 11 were cisgender men, 2 were cisgender women and 32 were transgender women.

Of the 203 partners of trans women, 97% were cisgender men. Only 2 trans-partner women were cisgender women and 5 were transgender women. They all reported that their recent sexual partners were trans women (100%), cis women (55%) and cis men (7%).

In other words, a clear distinction was made between groups. This casts doubt on the hypothesis of a study conducted earlier in the US that argued that there may be a direct relationship between sexual transmission of HIV between trans women or male partners of trans women and other men.

Participants' reports on sexual partners and sexual preferences often coincided. So 83% of trans-women partners reported that they were attracted by transgender women, 68% - cisgender women. But only 8.9% said they were attracted to cisgender men.

A minority of men who have sex with men were very different from other partners of trans women. They were nine times more likely to know that they were homosexual, and almost five times more likely to find out their HIV status than other partners.

Despite the fact that the proportion of trans-women partners who knew that they had HIV was lower by 3.5% than among men who have sex with men (11.6%) or among trans-women (5 , 6%), it is still ten times higher than the prevalence of HIV infection among the general male population of Peru.

In addition, only 46% of cis-men (partners) at the time of the study knew about their HIV-status, while this indicator was equal to 58% in the group of trans women and 78% - MSM.

One of the conclusions of the analysis was that among trans women there was often the so-called transactional sex (for money, food, gifts or housing), but they were not always “sex workers” and men were “clients”.

90% of trans women reported “selling” sex, but only 56% of partners confirmed their words. However, at the same time, when 78% of partners reported “buying” sex, only 57% of trans women confirmed their words. A minority of gay and bisexual men also often sold sex, but almost never bought it.

Dr. Long emphasized that although the survey did not find a complete explanation of why HIV infection rates are higher among transgender women in general, he found that their partners were separated from gay men and represented an independent risk group.