Exploring the long-term sequelae of childhood sexual abuse on risky sexual behavior among Chinese transgender women.

Introduction: Childhood sexual abuse (CSA) is a hidden but serious public health issue that can lead to a series of behavioral consequences and health problems in adulthood. It has been well documented that transgender women (TGW) have a high prevalence of CSA victimization. Moreover, risky sexual behaviors are also widespread among TGW; nevertheless, research investigating the associations between CSA victimization and risky sexual behaviors in TGW represents a gap in the literature. Methods: Our research was carried out mainly in Shenyang of China from November 2018 to January 2019. Sociodemographic characteristics, as well as information on participants' HIV awareness and sexual behaviors, were collected through face-to-face interviews. The impact of CSA was examined through hierarchical logistic regression, adjusted for sociodemographic factors and HIV awareness. Results: In the sample of 247 adult TGW, 14.2% of them had a CSA history. In the previous 6 months, 30.8% of the participants reported condomless anal intercourse (CAI) and 38.5% of them had multiple sexual partners (MSP). The findings demonstrated that TGW with CSA history were more likely to take part in CAI (p = 0.001, OR = 4.252) or have MSP (p = 0.004, OR = 3.260) in adulthood. Furthermore, HIV knowledge was not a predictor of CAI or MSP, but higher HIV risk perception was associated with a greater probability of CAI. Conclusion: Transgender women with a history of CSA were more prone to engage in CAI and have MSP in China.

The effects of intimate relationship characteristics on unprotected anal intercourse among same-sex male couples in China: a dyadic analysis using the actor-partner interdependence model.

BACKGROUND: Unprotected anal intercourse (UAI) within the context of concurrent sexual relationship are prevalent among men who have sex with men (MSM) who have regular male sex partners and it aggravates the risk of HIV infection among this community. The aim of this study was to assess the effect of intimate relationship characteristics on UAI among MSM couples at the dyadic level. METHODS: Two hundred four MSM couples were recruited from a HIV testing clinic from April 2017 to April 2018 in Guangzhou, China. The actor-partner interdependence model (APIM) was applied for dyadic analysis. Each MSM couple was divided into the insertive role and the receptive role according to their regular anal sex role. In this context, actor effect is the impact of an MSM's intimate relationship characteristics on his own UAI, and partner effect is the impact of his partner's intimate relationship characteristics on his UAI. RESULTS: Of the 408 participants, 58.82% had UAI with regular male sex partner (UAI-RP) and 8.09% had concurrent UAI. Intimate relationship characteristics were associated with concurrent UAI, but not associated with UAI-RP. For the receptive role, his relationship investment exerted significant actor and partner effects on concurrent UAI (AOR actor = 1.31, P < 0.001; AOR partner = 1.17, P < 0.001). Meanwhile, receptive role's violence experience within relationship exerted significant actor effects on his own concurrent UAI (AOR actor = 6.43, P = 0.044). CONCLUSIONS: Relationship investment and violence experience influenced concurrent UAI among MSM couples and it varied in different sex roles. Additional assistance on empowerment, relationship therapy and sexual agreement is urgently needed to reduce their high possibility on engagement of HIV-related risk behaviors.

Prevalence of condomless anal intercourse and associated risk factors among men who have sex with men in Bamako, Mali.

BACKGROUND: Men who have sex with men (MSM) are disparately impacted by HIV in sub-Saharan Africa and condomless anal intercourse (CAI) is a major driver of HIV transmission. The objective of the current study was to identify factors associated with CAI among MSM in Bamako, Mali, among whom HIV prevalence was 13.7%. METHODS: A bio-behavioral survey was conducted between October 2014 and February 2015 using respondent-driven sampling to recruit 552 adult MSM. Weighted statistical analyses were conducted to determine the prevalence of CAI with one's most recent male partner and survey logistic procedures were used to identify associated factors. RESULTS: The prevalence of CAI with one's most recent male partner was 40.7%. Associated factors included: inability to get a condom when needed (aOR = 5.8, 95%CI: 2.7-12.3) and believing CAI is acceptable under some circumstances (aOR = 8.4, 95%CI: 4.4-16.2). CONCLUSIONS: Programs addressing HIV among MSM in Mali should aim to increase access to condoms and education about HIV prevention through consistent condom use during anal intercourse.

Discriminatory distress, HIV risk behavior, and community participation among American Indian/Alaska Native men who have sex with men.

Objectives Research regarding men who have sex with men (MSM) indicates that exposure to discrimination based on race and sexuality are positively associated with increased incidence of unprotected anal intercourse (UAI). In an effort to better understand this association, we assessed the associations of discriminatory distress with UAI among a sample of 183 American Indian and Alaska Native (AI/AN) MSM using survey data drawn from the HONOR Project. Design The HONOR Project examined the relationship between trauma, coping, and health behaviors among Two-Spirits (a contemporary name for gender and sexual minorities among American Indian and Alaska Native people). Results Using multivariable logistic regression techniques, our analysis showed participants reporting higher mean levels of distress from two-spirit discrimination had higher odds of reporting UAI (OR = 1.99, 95% CI, 1.19-3.32) compared to those reporting lower levels of distress. This analysis also showed lower odds of engaging in UAI among participants reporting higher levels of participation in LGBT specific online forums (OR = 0.86, CI = 0.75, 0.99; p < .05) and attending Two-Spirit events (OR = 0.82, CI = 0.71, 0.94; p < .01). Conclusions Future prevention research and program designs should address the differential impact of discrimination and community participation on sexual behavior specifically among AI/AN MSM.

Influencing factors of unprotected anal intercourse among Tianjin male homosexuals who used recreational drugs / 上海预防医学

Objective:To explore the demographic characteristics and sexual behavior of men who have sex with men （MSM） in Tianjin， and to compare these aspects between recreational drug users and non-users. Methods:This research was conducted by Tianjin Centers for Disease Control and Prevention. From July to September 2015， various methods such as simple random sampling and snowball sampling were used to recruit MSM. Information was collected through on-site questionnaire surveys， and laboratory tests were conducted to detect human immunodeficiency virus （HIV） infection status in the research subjects. Statistical description and frequency distribution tests on demographic information and behavioral variables were performed. Results:A total of 410 qualified participants， ranged from 17 to 70 years old， were included. A total of 297 （72.4%） MSM were unmarried， 194 （47.3%） had monthly income over 3 000 yuan， 182 （44.4%） MSM had high school education， and 366 （89.3%） were working full-time. Among all 410 participants， 208 MSM self-reported using recreational drugs. Among them， 140 MSM had used Rush Popper. Influencing factors of unprotected anal intercourse （UAI） among Rush Popper users include： more than 30 years old， average monthly income less than 5 000 yuan， and sex with temporary partners （all P<0.05）. Conclusion:Among MSM in Tianjin， the use of recreational drugs is quite common， and Rush Popper is the most commonly used recreational drug. Therefore， it is necessary to establish and strengthen the relevant laws and regulations for the reduction of Rush Popper circulation among the MSM population.

Association between sexual sensation seeking and sexual risk behaviors among men who have sex with men in Guangzhou / 中华疾病控制杂志

Objective To evaluate the association between sexual sensation seeking (SSS) and sexual risk behaviors among men who have sex with men (MSM) in Guangzhou. Methods MSM aged 18 and over were recruited in Zhitong Charity from June 2017 to April 2018. Data on socio-demographic characteristics, sexual behaviors and SSS were collected using an electronic questionnaire. Logistic regression analyses were performed to evaluate the association between SSS and sexual risk behaviors. Results A total of 500 MSM were included in the current study. The mean age of the participants was (27.77±5.96) years old. The multiple logistic regression analyses showed that MSM with high SSS scores were more likely to engage in multiple sexual partners (OR=2.05, 95% CI: 1.40-2.30,P<0.001), one-night stand (OR=2.11, 95% CI: 1.44-3.09,P<0.001), and unprotected anal intercourse (OR=1.70, 95% CI: 1.16-2.50,P=0.007) than those with low SSS scores. Conclusions High SSS is associated with an increased risk of sexual risk behavior among MSM in Guangzhou. The behavior intervention strategy should be tailored for MSM with high SSS to improve the effectiveness to reduce sexual risk behaviors.

A cross-sectional study of the relationship between sexual compulsivity and unprotected anal intercourse among men who have sex with men in shanghai, China.

BACKGROUND: HIV prevalence among men who have sex with men (MSM) in China is rising rapidly, and unprotected anal intercourse (UAI) is associated with HIV transmission. Recent research has shown that associations between UAI and other factors can differ according to the type of sex partners, including regular partners and casual partners. This study aimed to explore the relationship between sexual compulsivity and UAI according to partner type among MSM in Shanghai, China. METHODS: A cross-sectional study was conducted among 547 MSM from four districts in Shanghai, China. All participants were recruited using snowball sampling. The Sexual Compulsivity Scale was used to evaluate participants' sexual compulsivity. Multivariable logistic regression was used to identify factors associated with sexual compulsivity and UAI. The mediation effects of substance use before sex on the relationship between sexual compulsivity and UAI were tested through mediation analyses. RESULTS: After adjusting for sociodemographic variables, sexual compulsivity was associated with overall UAI (adjusted odds ratios [AOR] = 1.039, 95% confidence intervals [CI] = 1.004-1.075), UAI with non-regular sex partners (AOR = 1.089, 95% CI = 1.033-1.148) and UAI with commercial sex partners (AOR = 1.185, 95% CI = 1.042-1.349). No significant association was found between sexual compulsivity and UAI with regular sex partners (AOR = 1.029, 95% CI = 0.984-1.077). Mediation analyses indicated that the relationship between sexual compulsivity and UAI was not mediated by either alcohol use before sex or drug use before sex. CONCLUSIONS: The association between sexual compulsivity and UAI varies depending on the type of UAI partner. Therefore, individuals may engage in different types of UAI for different reasons, and tailored HIV cognitive-behavioral intervention programs are needed.

[Study on unprotected anal intercourse behavior in HIV-positive men who have sex with men in the context of knowing their HIV infection status in Chengdu].

Objective: To identify related factors associated with unprotected anal intercourse (UAI) among HIV-positive men who have sex with men (MSM) in the context of knowing their HIV infection status. Methods: HIV positive MSM who known that they had been infected with HIV for more than 6 months and accepted follow up services were recruited by convenience sampling method in Chengdu 2015. Semi-structured questionnaire was used to collect their information, such as demographic characteristics, antiviral therapy and sexual behavior characteristics etc. Logistic regression model was used for univariate and multivariate analyses. Results: A total of 330 HIV- positive MSM were recruited, 201 eligible MSM were interviewed. The prevalence of UAI in recent six months was 18.41% (37/201). The results of multivariate logistic regression analysis revealed that the number of anal intercourse with male ≥3 in last month (OR=6.22, 95%CI: 1.88-20.56), low education level (OR=7.29, 95%CI: 1.36-39.16), married, divorced or widowed status (OR=4.65, 95%CI: 1.13-19.17), homosexual cohabitation (OR=3.32, 95%CI: 1.01-10.95) were the risk factors related with UAI among the HIV-positive MSM. Conclusion: Frequent homosexual anal intercourse, low education level, married, divorced or widowed status and homosexual cohabitation might be the risk factors related with UAI in HIV-positive MSM in Chengdu.

Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India.

Syndemic theory describes the clustering and synergistic interaction of disease driven by contextual and social factors, which worsen health outcomes for a population, and has been applied to men who have sex with men (MSM) and their risk for HIV and other sexually transmitted infections. Recent reviews, however, have critiqued prevailing approaches in syndemic studies that assess only additive associations without evaluation of synergy. Following these suggestions, we compared the traditional additive approach with a test for synergistic association of 5 syndemic conditions (alcohol dependence, illicit drug use, depression, intimate partner violence (IPV), and childhood sexual abuse (CSA)) with unprotected anal intercourse (UAI) and active syphilis infection among 11,771 MSM recruited through respondent driven sampling from 12 cities in India. UAI was assessed via self-report and active syphilis infection was diagnosed by RPR and THPA tests. An additive association was explored using a condition count (range 0-5), and synergy was tested using relative excess risk due to interactions (RERIs) calculated from all 2-way and common 3-way interactions between conditions in adjusted regression models. There was a significant dose response associated with the syndemic count and UAI, and a similar pattern for syphilis, though not statistically significant. RERIs showed synergy for only one pair of conditions for UAI and syphilis, respectively: IPV + depression and alcohol dependence + illicit drug use. In this study, we found an additive association between syndemic conditions and UAI with evidence of synergistic interaction between a pair of psychosocial conditions, and no significant additive association, but a synergistic interaction between another pair of psychosocial conditions for syphilis. Our results lend further support to a critical reassessment of syndemic analyses. Closer attention to the cumulative development, underlying causal pathways, and possible synergistic interaction of co-occurring epidemics through combined qualitative and quantitative methodologies may yield more effective interventions for vulnerable, marginalized populations.

Intimate relationship characteristics as determinants of HIV risk among men who have sex with regular male sex partners: a cross-sectional study in Guangzhou, China.

BACKGROUND: China faces a serious HIV epidemic among men who have sex with men (MSM), and a large proportion of new infections are attributed to their regular male sex partners (RP). The objective of this study was to investigate the association between intimate relationship characteristics and HIV-related behaviors among MSM with RP in Guangzhou, China. METHODS: A convenience-sampling method was used in data collection. A total of 608 MSM were screened, of whom 406 HIV negative MSM with at least one RP in the past six months were used for data analysis. Three-step logistic regressions were used to analyze the data. RESULTS: The prevalence of unprotected anal intercourse (UAI) with regular male sex partners, non-regular male sex partners, and concurrent UAI in the past six months was 53.9%, 23.6%, 20.7%, respectively. Variables associated with UAI with regular male sex partners included expectations for this relationship (adjusted odds ratio in multiple forward stepwise logistic regression, ORm = 1.66) and open communication about the sexual relationship (ORm = 1.79), while expectations for the relationship (ORm = 0.46 to 0.54) and conflicts of interest (ORm = 5.46 to 5.97) were associated with concurrent UAI and UAI with non-regular male sex partners. CONCLUSION: Intimate relationship characteristics were related to HIV-related risk behaviors. Future HIV prevention interventions should take MSM couples into consideration, include a focus on the quality of their intimate relationships, and encourage open communication about their sexual relationships.

Place and practice: Sexual risk behaviour while travelling abroad among Swedish men who have sex with men.

BACKGROUND: The proportion of newly diagnosed HIV and STI cases among men who have sex with men (MSM) that were contracted abroad has been increasing in Sweden. The present study explored factors associated with casual unprotected anal intercourse (UAI) and travelling abroad among MSM. METHODS: A cross-sectional stratified survey with 2751 MSM was conducted. The frequency of sexual practices among men who had casual UAI abroad (<12 months) with that of men who had casual UAI only in Sweden were compared and factors associated with casual UAI abroad were identified through regression analysis. RESULTS: Factors associated with casual UAI abroad within the previous 12 months were: visit a gay sauna (OR 6.15, 95% CI 3.43-11.06), visit gay café/bar/pub (OR 3.24, 95% CI 1.62-6.48), experience of UAI with a foreign visitor (OR 4.80, 95% CI 2.37-9.75), living with HIV (OR 2.73, 95% CI 1.15-6.48), reporting poor overall health (OR 2.24, 95% CI 1.13-4.44), being born outside Sweden (OR 2.21, 95% CI 1.08-4.53), and being vaccinated against hepatitis A, hepatitis B, or both (OR 1.92, 95% CI 1.13-3.27). CONCLUSION: MSM who engage in casual UAI abroad need to increase their understanding of related risks and that risk varies with place and practice. Health care professionals should address the preventive needs of traveling MSM and offer counselling and STI-preventive measures.

Review of high-risk sexual behaviors in men who have sex with men: influencing factors and theoretical models / 上海交通大学学报（医学版）

The disproportionately high prevalence of HIV among men who have sex with men (MSM) is associated with the prevalence of unprotected anal intercourse (UAI), which has been the predominant high-risk behavior of HIV acquisition and transmission. MSM have become a target population for HIV prevention. The aspects affecting the high-risk sexual behaviors of MSM mainly include personal factors, environmental factors, and social psychological factors. Currently widely applied models of acquired immunodeficiency syndrome (AIDS) behavioral intervention include KABP (knowledge, attitude, belief, and practice) model, health belief model, theory of reasoned action, social network theory, and so on. These theories provide a reference for studying various influential factors and elaborating the occurrence of high-risk sexual behaviors of MSM. Exploring and building the comprehensive model and integrating the influencing factors of high-risk sexual behaviors of MSM can help us to predict their ultimate actions in the future. Similarly, it will also provide ideas for the further preventions and interventions in MSM.

Study on unprotected anal intercourse behavior in HIV-positive men who have sex with men in the context of knowing their HIV infection status in Chengdu / 中华流行病学杂志

Objective To identify related factors associated with unprotected anal intercourse (UAI) among HIV-positive men who have sex with men (MSM) in the context of knowing their HIV infection status.Methods HIV positive MSM who known that they had been infected with HIV for more than 6 months and accepted follow up services were recruited by convenience sampling method in Chengdu 2015.Semi-structured questionnaire was used to collect their information,such as demographic characteristics,antiviral therapy and sexual behavior characteristics etc.Logistic regression model was used for univariate and multivariate analyses.Results A total of 330 HIV-positive MSM were recruited,201 eligible MSM were interviewed.The prevalence of UAI in recent six months was 18.41％ (37/201).The results of multivariate logistic regression analysis revealed that the number of anal intercourse with male ≥3 in last month (OR=6.22,95％CI:1.88-20.56),low education level (OR=7.29,95％CI:1.36-39.16),married,divorced or widowed status (OR=4.65,95％CI:1.13-19.17),homosexual cohabitation (OR=3.32,95％CI:1.01-10.95) were the risk factors related with UAI among the HIV-positive MSM.Conclusion Frequent homosexual anal intercourse,low education level,married,divorced or widowed status and homosexual cohabitation might be the risk factors related with UAI in HIV-positive MSM in Chengdu.

Study on unprotected anal intercourse behavior in HIV-positive men who have sex with men in the context of knowing their HIV infection status in Chengdu / 中华流行病学杂志

Objective To identify related factors associated with unprotected anal intercourse (UAI) among HIV-positive men who have sex with men (MSM) in the context of knowing their HIV infection status.Methods HIV positive MSM who known that they had been infected with HIV for more than 6 months and accepted follow up services were recruited by convenience sampling method in Chengdu 2015.Semi-structured questionnaire was used to collect their information,such as demographic characteristics,antiviral therapy and sexual behavior characteristics etc.Logistic regression model was used for univariate and multivariate analyses.Results A total of 330 HIV-positive MSM were recruited,201 eligible MSM were interviewed.The prevalence of UAI in recent six months was 18.41％ (37/201).The results of multivariate logistic regression analysis revealed that the number of anal intercourse with male ≥3 in last month (OR=6.22,95％CI:1.88-20.56),low education level (OR=7.29,95％CI:1.36-39.16),married,divorced or widowed status (OR=4.65,95％CI:1.13-19.17),homosexual cohabitation (OR=3.32,95％CI:1.01-10.95) were the risk factors related with UAI among the HIV-positive MSM.Conclusion Frequent homosexual anal intercourse,low education level,married,divorced or widowed status and homosexual cohabitation might be the risk factors related with UAI in HIV-positive MSM in Chengdu.

[Research progress on unprotected anal intercourse and its influencing factors in men who have sex with men].

The prevalence of HIV infections continues to rise among Chinese MSM. This population is prone to has high-risk behaviors including having multiple sexual partners, unprotected anal intercourse (UAI), etc. This paper summarizes the situation of UAI and related influencing factors, including age, educational level, number of sexual partners, recreational drug abusing and related status of discrimination, etc. The purpose of this article is to provide reference for targeted intervention and prevention of HIV among MSM population.

HIV infected men who have sex with men in Israel: knowledge, attitudes and sexual behavior.

BACKGROUND: HIV-infected (HIVI) men who have sex with men (MSM) may transmit HIV to their sero-discordant sex partner/s. This study assesses the knowledge, attitudes and sex-practices of Israeli HIVI-MSM. METHODS: This cross-sectional study compared HIVI-MSM to self-reported HIV-uninfected (HIVU) MSM by using anonymous questionnaires that were distributed in AIDS-treatment centers and gay-related internet-sites in 2015. Unprotected anal intercourse (UAI) in the last 6 months was the outcome variable. RESULTS: Of 300 HIVI-MSM and 1299 HIVU-MSM, UAI with sero-discordant/unknown-status partner/s was performed by 12.1% and 17.9%, respectively, p=0.02. UAI with sero-discordant/unknown-status among HIVI-MSM and HIVU-MSM was associated with the type of partnership: 37.7% vs. 52.4% for steady partner/s, 19.0% vs. 39.9% for sex-buddies and 23.5% vs. 24.0% for casual partner/s (p<0.001, p=0.01, p=0.6), respectively. On these occasions, HIVI-MSM were more likely to be receptive during UAI: 92.3%, 87.5% and 83.3% for steady partner/s, sex buddies and casual partner/s, respectively. In cases HIVI-MSM performed UAI, 31.3% expected their partner/s to share responsibility for condom-use vs. 9.7% of HIVU-MSM. HIVI-MSM were involved in risky sexual-behaviors, such as substances-use, earlier sexual debut and sex for money. HIVI-MSM were more likely to disclose their HIV-status with their partner before sex and demonstrated better knowledge about HIV-transmission than HIVU-MSM. CONCLUSION: HIVI-MSM performed UAI with sero-discordant/unknown-status partner/s less frequently than HIVU-MSM. Their condom-use practices were associated with the type of partner, and were lower for casual vs. steady partners or sex-buddies. HIVI-MSM tended to use sero-adaptive strategies to reduce the potential risk of HIV-transmission to their sero-discordant/unknown-status partner/s.

Prevalence of and factors associated with unprotected anal intercourse with regular and nonregular male sexual partners among newly diagnosed HIV-positive men who have sex with men in China.

OBJECTIVES: This study investigated the prevalence of, and multi-dimensional factors associated with, unprotected anal intercourse (UAI) with regular male sexual partners ('regular partners') and nonregular male sexual partners ('nonregular partners') among newly diagnosed HIV-positive men who have sex with men (MSM) in Chengdu, China. METHODS: A total of 225 newly diagnosed HIV-positive MSM were interviewed using a combined interviewer-computer-assisted method in Chengdu, China. RESULTS: The prevalence of UAI with regular and nonregular partners since diagnosis was 27.7% and 33.8% among participants reporting having sex with regular and nonregular partners (n = 159 and 133), respectively. Adjusted analysis showed that: (1) cognitive variables based on the Health Belief Model (perceived susceptibility to HIV transmission and perceived severity of the consequences of HIV transmission, perceived barriers and perceived self-efficacy related to consistent condom use), (2) emotion-related variables (worry about transmitting HIV to others), (3) psychological factors (post-traumatic growth) and (4) socio-structural factors (perceived partners' responsibility for condom use) were significantly associated with UAI with regular and/or nonregular partners. CONCLUSIONS: Interventions are warranted, and should be designed with consideration of multi-dimensional factors and be partner type-specific.

Research progress on unprotected anal intercourse and its influencing factors in men who have sex with men / 中华流行病学杂志

The prevalence of HIV infections continues to rise among Chinese MSM. This population is prone to has high-risk behaviors including having multiple sexual partners, unprotected anal intercourse (UAI), etc. This paper summarizes the situation of UAI and related influencing factors, including age, educational level, number of sexual partners, recreational drug abusing and related status of discrimination, etc. The purpose of this article is to provide reference for targeted intervention and prevention of HIV among MSM population.

Research progress on unprotected anal intercourse and its influencing factors in men who have sex with men / 中华流行病学杂志

The prevalence of HIV infections continues to rise among Chinese MSM. This population is prone to has high-risk behaviors including having multiple sexual partners, unprotected anal intercourse (UAI), etc. This paper summarizes the situation of UAI and related influencing factors, including age, educational level, number of sexual partners, recreational drug abusing and related status of discrimination, etc. The purpose of this article is to provide reference for targeted intervention and prevention of HIV among MSM population.

Prevalence and associated factors of condomless receptive anal intercourse with male clients among transgender women sex workers in Shenyang, China.

INTRODUCTION: Globally, transgender women sex workers have a high prevalence of HIV and condomless receptive anal intercourse with male clients (CRAIMC). We investigated the prevalence of CRAIMC and factors associated with CRAIMC among transgender women sex workers in China. METHODS: In 2014, we anonymously interviewed 220 transgender women sex workers face to face in Shenyang, China. Those who self-reported as HIV negative or as having unknown HIV serostatus were invited to take up free, anonymous HIV rapid testing (n=183); 90 did so. Using CRAIMC in the last month as the dependent variable, three types of associated factors were investigated, in addition to background factors: feminizing medical interventions, sex work and perceptions related to condom use. Univariate and multiple logistic regression models were fitted. RESULTS: Of the participants, 16.8% self-reported as HIV positive and 9.1% were detected to be HIV positive through free HIV testing; 26.8% had had CRAIMC in the last month, 45.5% had performed sex work in other Chinese cities (last year), and 23.2% had had condomless anal intercourse with men who were non-clients. In the adjusted analysis, significant factors associated with CRAIMC (last month) included the following: 1) any feminizing medical intervention performed (adjusted odds ratio, AOR: 2.22); 2) sex-work-related factors, including recruitment of male clients most often at hotels (AOR: 5.02) and charge per episode of transactional sex (201 to 400 RMB, AOR: 0.27; reference group: ≤100 RMB); and 3) perceptions related to condom use, including perceived transgender identity's impact on condomless sex such as wearing feminine attire, concern about exposing their status as a transgender woman to male clients (AOR: 1.20) and perceived self-efficacy of consistent condom use with male clients (AOR: 0.56). Perceived self-efficacy of consistent condom use with male clients fully mediated the association between perceived transgender identity's impact on condomless sex and CRAIMC. CONCLUSIONS: HIV prevalence among transgender women sex workers was high but probably underestimated. The high prevalence of condomless anal intercourse with male non-clients and high mobility in sex work among this population in China are causes for concern. Risk factors for CRAIMC were multidimensional and should be considered when designing interventions targeting transgender women sex workers. Such interventions are urgently needed.