Discordance between sexual identity and sexual behavior is not new; however, little is known about the HIV risk behaviors of heterosexually identified men who have occasional sex with a male and/or a male-to-female transgender woman. Open-ended qualitative interviews were conducted with 31 heterosexually identified men who reported at least one sexual encounter with a male and/or a transwoman in the previous 12 months. Sixty-one percent were African American/Black, the mean age was 38.9 years (SD = 8.4), 58.1% reported current substance use, and 58.1% were HIV infected. Among those who had a sexual encounter with a transwoman, the majority (81.3%) were the insertive partner during anal sex. In comparison, among those who had a sexual encounter with a male partner, almost one-half (42.9%) were the receptive partner during anal sex. HIV-infected participants were more likely to use a condom with a biological female partner than with a male or transwoman partner. HIV-uninfected participants reported limited condom use with any partner type, highlighting their potential role in the diffusion of HIV and other sexually transmitted infections. Participants’ HIV status, partner type, substance use, and cultural factors influenced sexual decision-making and HIV risk behaviors.
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