Gamarel, K.E., Reisner, S.L., Darbes, L.A., et al. AIDS Care (August 2015), E-publication ahead of print.
The authors of this study used data from a community sample of transgender women and their primary male sexual partners (N = 191 couples) to examine (1) the prevalence and type of sexual agreements among these couples; (2) whether intentions for sexual agreement were associated with extra-dyadic HIV risk (condomless sex with outside partners); and (3) whether these intentions were associated with HIV serodiscordant intra-dyadic risk (condomless sex with main partners). Overall, 55.1 percent (n = 102) of couples reported concordance in their sexual agreement; 40.0 percent (n = 74) had monogamous agreements and 15.1 percent (n = 28) had open agreements. However, 44.9 percent of couples reported discrepant agreements (one partner indicated having an open agreement and the other reported a monogamous agreement). For male partners, extra-dyadic risk was associated with their own and their partners’ reasons for sexual agreement and male partners who engaged in extra-dyadic HIV risk were more likely to have condomless (and risky) sex within the partnership. The authors concluded that researchers and prevention providers should involve both transgender women and their male partners to understand the couples’ agreements and equip them with skills to discuss their agreements openly, so that both partners can make informed choices about their acceptable levels of risk.