Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males

Abstract

Female-to-male trans masculine adults who have sex with cisgender (non-transgender) males (TMSM) represent an understudied population in relation to HIV/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. 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 past-6-month sexual partners, 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.

HIV Prevention Among Transgender Populations: Knowledge Gaps and Evidence for Action

“…Both social oppression and psychological distress produced under these circumstances increase engagement in high-risk contexts such as exchange sex, sex to obtain gender affirmation, and illicit injections of hormones or silicone. Research with transgender men who have sex with men indicate stigma, syndemic conditions, and gender affirmation may also play important roles in their sexual risk behavior [37]. …”

Child abuse victimization among transgender and gender nonconforming people: A systematic review

“…In four studies that measured childhood gender nonconformity (CGNC), children who exhibited CGNC were more likely to be abused . In the eight studies that investigated the association of childhood abuse among transgender and gender nonconforming people, it was associated with negative adult outcomes, such as sex without a condom, self‐harm, past year drug use, post‐traumatic stress disorder (PTSD) symptoms, and suicide attempts …”

Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts

“…Furthermore, there is a paucity of research on transgender men and HIV. A small number of convenience sample studies indicate HIV prevalence in a range from 0% to 3% (Reisner, White Hughto, Pardee, & Sevelius, 2016). More research is needed on this population and HIV risk.…”