HIV risk and prevention among cisgender men who have sex with transgender women or transfeminine nonbinary people

Key take-home messages

• Estimates of HIV prevalence among cisgender men who have sex with transgender women vary widely: a meta-analysis of six studies (367 total study participants) estimated an HIV self-reported prevalence of around 30% among cisgender men who have sex with transgender women, with nearly half of them reporting condomless anal intercourse with transgender women, suggesting substantial transmission risk within and across sexual networks. At the same time, other studies suggest a lower HIV prevalence of around 5% among cisgender men who partner with transgender women (131 total study participants).

• Cisgender men who have sex with transgender women often also have sexual partnerships with cisgender men, cisgender women, or both, in addition to transgender women, which positions this group as a potential “bridge” for HIV transmission between different population groups due to overlapping partnerships rather than individual behaviour alone.

• Phylogenetic analyses show that HIV genetic sequences of cisgender men who have sex with transgender women cluster more often with those of transgender women than with those of men who have sex with men, suggesting distinct HIV transmission dynamics

• Literature describes complex and intersecting factors that influence HIV risk for cisgender men who have sex with transgender women, which include: sexual risk behaviours (e.g. condomless sex), structural vulnerabilities, mental and behavioural health (e.g. depression and substance use), stigma (including social and relationship stigma), as well as sexual identity-related pressures, and relationship dynamics.

• A 2023 study of five surveillance data sources in Washington State (U.S.) found that cisgender men who have sex with transgender women were significantly less likely to use PrEP but more likely to have an HIV test in the past year.

• Cisgender men who have sex with transgender women may encounter persistent barriers related to PrEP and HIV testing uptake—such as medical mistrust, low perceived efficacy, and negative attitudes toward HIV self-testing—leading to underutilization of HIV prevention strategies.

• Couples-focused HIV prevention interventions, such as Couples HIV Intervention Program (CHIP) and “It Takes Two” have shown promising reductions in condomless sex and relationship stigma, yet such programs remain uncommon and are rarely integrated into public health practice.

• Overall, cisgender men who have sex with transgender women are not clearly categorized using conventional HIV risk and surveillance categories. Future research would benefit from using an intersectionality lens and a syndemics-based framework to examine available evidence on interacting structural, social, behavioural and physical health characteristics affecting HIV risk and outcomes for cisgender men who have sex with transgender partners.

• This review did not identify any studies that examined HIV treatment and care among cisgender men who have sex with transgender women, or studies that specifically focused on cisgender men who have sex with transfeminine nonbinary sexual partners.

• Epidemiology and Determinants of Health
  • Epidemiology
  • Determinants of Health
• Determinants of Health
  • Stigma/discrimination
• Population(s)
  • Men who have sex with men
  • Transgender communities
  • Heterosexual men
  • General HIV- population
• Prevention, Engagement and Care Cascade
  • Prevention
• Prevention
  • Sexual risk behaviour
  • Biomedical interventions
  • Education/media campaigns
• Testing
  • Testing
• Health Systems
  • Governance arrangements
  • Delivery arrangements