Background: Research suggests that because of economic necessity, many male-to-female (MTF) transgender individuals trade sex for money, drugs, housing, and other things they may need. To date, no studies have quantitatively assessed psychosocial correlates of condom use with this population. Methods: We conducted a cross sectional study with 190 MTF transgender individuals involved in sex trade in San Francisco, California. Multivariate logistic regression was used to determine factors independently associated with inconsistent condom use during receptive anal sex with exchange partners. Results: About one fifth of our participants reported inconsistent condom use during receptive anal sex in the past 6 months. In the multivariate model, low self-esteem [adjusted odds ratio (AOR) = 3.09; 95% confidence interval (CI) (1.28, 7.47)], a history of forced sex or rape [AOR = 2.91; 95% CI (1.06, 8.01)], and use of crack-cocaine [AOR = 2.59; 95% CI (1.09, 6.13)] were independently associated with inconsistent condom use. Conclusions: Our findings highlight an urgent need for multilevel risk reduction interventions for MTF transgender individuals involved in sex trade. Such interventions will be most effective if they address the psychosocial context of sexual risk taking by focusing on issues such as low self-esteem, sexual violence, and illicit drug use. © CSIRO 2008.

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social psychology sexual behavior multivariate logistic regression analysis correlation analysis personal needs human Health Behavior middle aged Odds Ratio violence condom Condoms Confidence Intervals male to female transsexual housing transsexualism self esteem Unsafe Sex Cross-Sectional Studies cocaine United States cocaine dependence Cocaine-Related Disorders Crack Cocaine Humans Adolescent California male female Socioeconomic Factors Multivariate Analysis self concept prostitution Article high risk behavior Risk-Taking Questionnaires adult major clinical study drug abuse illicit drug risk reduction Rape