Contextual Influences on Sexual Risk-Taking in the Transgender Community‪.‬

The transgender community is a heterogeneous group composed of individuals who cross or transcend the gender binary (Bockting, Robinson, Forberg, & Scheltema, 2005). Despite the lack of reliable estimates of the size of this community (Feldman & Bockting, 2003), HIV prevalence and incidence rates within certain subgroups of this population are well-documented. For example, in 2006, the estimated HIV prevalence rate among male-to-female (MTF) transsexuals in San Francisco was 22.8% , a rate similar to that of men who have sex with men (San Francisco Department of Public Health, 2006). Studies conducted with MTF transsexuals in other metropolitan areas documented HIV prevalence rates ranging from 11% to 78% (Garofalo, Deleon, Osmer, Doll, & Harper, 2006), and a recent meta-analysis of research on HIV among MTF transsexuals reported an overall incidence rate of 28% (Herbst et al., 2008). Compared to estimates indicating that HIV affects approximately 0.3% of the general population, these HIV prevalence and incidence rates are disturbingly high (Kenagy, 2005b). Transgender HIV risk behavior and its contextual predictors are also well-documented. Identified risks for transgender adults, particularly MTF transsexuals who have been the focus of most transgender HIV risk assessments (Clements-Nolle, Wilkinson, Kitano, & Marx,