Relationship and Substance Use Correlates of Sexual Behavior among Transgender Men in the United States

Purpose: The goal of this study was to examine relationship and substance use correlates of condomless anal sex (CAS), a behavior associated with HIV and sexually transmitted infections (STIs), among a sample of transgender men in the United States. Methods: Secondary analyses were conducted on data from an online survey collected from November 2017 to March 2020. Recruitment occurred through social media and geosocial dating applications. The odds of CAS with casual male partners were predicted from socio-demographics, substance use, sexual behavior, pre-exposure prophylaxis (PrEP) use, relationship status, sexual agreements, and main partner identity. Results: A total of 2,231 transgender men completed the survey. Of these, 1,312 (58.8%) were single, and 919 (41.2%) were in a relationship (5.6% with a monogamous sexual agreement and 35.5% with a nonmonogamous sexual agreement). Among those in a relationship, 25.8% of those not on PrEP and 36.8% of those with a main male partner had CAS with a casual male partner. Logistic regression analyses indicated that heavy drinking (odds ratio [OR] = 1.31, p = 0.009), illicit drug use (OR = 1.98, p < 0.001), and identifying as gay (OR = 1.39, p = 0.004) were significantly associated with the odds of CAS with casual male partners. The odds of CAS with casual male partners did not differ across relationship status and sexual agreement groups (single, partnered-monogamous; partnered-nonmonogamous). Conclusions: These findings support the potential risk for HIV or STI transmission among transgender men, especially for those who are binge drinking and using illicit drugs.