Higher Risk of Transmitting HIV Found in Couples of Trans Women and Cisgender Men

HIV risk can vary by demographic and subgroup, with transgender individuals and men who have sex with men at particularly high risk.¹ A new study in BMC Public Health² adds a new layer to this risk, finding that couples that contain a transgender woman and a cisgender man are more susceptible to acquiring HIV compared with couples that only consist of transgender women.

Transgender women with cisgender men as sexual partners were more likely to contract HIV compared with transgender women with transgender women as sexual partners | Image credit: cunaplus - stock.adobe.com

The risk for acquiring HIV in transgender women and their sexual partners has received little research attention in the past, although some studies have found that transgender women may be more inclined to engage in sexual risk behavior with cisgender men. Social determinants of health can also affect the means by which HIV is contracted in this subgroup. This study aimed to assess the risk of acquiring HIV in transgender women who are partnered with either a cisgender man or another transgender woman. Differences in demographic, social, and behavioral determinants of health by partnership type were also examined in the study.

All data were collected through surveys conducted via Zoom between April 2020 and January 2021. All participants were compensated for participating and for referring others to participate. All participants were transgender women aged 18 years or older who lived in California, had a partner who was a transgender woman or a cisgender man, and spoke either Spanish or English. Gender identity, sexual orientation, social determinants of health, and race and ethnicity were collected from all participants.

The number of sexual partners, the type of sexual encounter (main, casual, or exchange), the number of exchange partners as applicable, and whether the participant had had sex in exchange for money or drugs were also asked in the survey. Risk behaviors, like condomless sex, were also surveyed along with questions of any concurrent sex. Use of pre-exposure prophylaxis, HIV testing, and knowledge of the status of their partner were assessed via questions in the survey.

There were 156 transgender women who participated in the study, who provided data on 336 sexual partners. A total of 81.9% of the partners were cisgender men, 69.9% were aged between 18 and 39 years, 59.1% were defined as straight, and 89.7% were HIV negative. The partners were primarily White (42.0%), with African American (23.7%) and Latinx (21.3%) partners also frequently reported. A total of 66.0% of the transgender women were aged 18 to 39 years, 47.1% identified as straight, and 79.5% were HIV negative. The transgender women had a more even spread of ethnicity, with 27.6% identifying as White, 25% as multiracial, and 23.7% as Latinx.

A total of 85.5% of the transgender women had at least 1 cisgender man as a sexual partner compared with 14.5% who had transgender women as partners. The partners were equally described as either a main partner (68.5%) or a casual partner (63.0%). Exchange partners made up 25% of the transgender women with cisgender men compared with only 5.6% of transgender women having a transgender woman as their exchange partner.

Transgender women were more likely to report exchange sex within 3 months (27.7% vs 4.6%) and receptive condomless anal sex in the previous 3 months (67.7% vs 31.8%) when they were with a cisgender man partner. All transgender women who reported having HIV had a cisgender man as a sexual partner. A total of 92.9% of transgender women with cisgender men as partners were receiving HIV care, with 85.7% reporting that they were virally suppressed.

There were some limitations to this study. The study was conducted during the COVID-19 pandemic, which made recruitment more challenging and limited the ability to conduct biomarker tests. The study sample was small, which could affect generalizability.

The researchers concluded that these results can act as a building block to help to understand the risk of HIV that transgender women face. “Research to improve impact in HIV prevention for trans women will also need to incorporate interventions for their cis men sexual partners,” the authors wrote.

References

1. Fast facts: HIV in the United States. CDC. April 22, 2024. Accessed August 18, 2025. https://www.cdc.gov/hiv/data-research/facts-stats/index.html

2. Wilson EC, Suprasert B, Trujillo D, et al. Structural disadvantage and HIV risk – comparing risk factors between trans women’s partnerships with cis men and women sexual partners. BMC Public Health. 2025;25:2813. doi:10.1186/s12889-025-23871-1