{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:20:01Z","timestamp":1791940801512,"version":"4.3.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2016,7,11]],"date-time":"2016-07-11T00:00:00Z","timestamp":1468195200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J STD AIDS"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:p>Female-to-male trans masculine adults who have sex with cisgender (non-transgender) males (TMSM) represent an understudied population in relation to HIV\/sexually transmitted infection (STI) risk. This study examined the role of syndemic conditions and social gender affirmation processes (living full-time in one\u2019s identified gender) in potentiating sexual risk among TMSM adults in Massachusetts, US. Cross-sectional data were restricted to TMSM who reported lifetime sexual behaviour with a cisgender male ( n\u2009=\u2009173; mean age\u2009=\u200929.4, SD\u2009=\u20099.6; 18.5% people of colour; 93.1% non-heterosexual identity; 56.1% hormones\/surgery). Sexual risk outcomes were: lifetime STI diagnoses, three or more sexual partners in the previous six months, and condomless anal\/vaginal sex at last encounter with a cisgender male. Age- and survey mode-adjusted logistic regression models regressed sexual risk outcomes on the main effect of syndemics (six indicators summed: binge drinking, substance use, depression, anxiety, childhood abuse, intimate partner violence), followed by the interaction of syndemics and social gender affirmation. Syndemics were associated with increased odds of all sexual risk indicators (adjusted odds ratios [aORs]\u2009=\u20091.32\u20131.55; p\u2009&lt;\u20090.0001). Social gender affirmation moderated the association between syndemics and condomless anal\/vaginal sex at last encounter with a cisgender male ( p\u2009&lt;\u20090.0001). Syndemics were associated with sexual risk in TMSM who had socially affirmed their gender (aOR\u2009=\u20091.79; 95% CI\u2009=\u20091.42\u20132.25; p\u2009&lt;\u20090.001), but not among those TMSM who had not (aOR\u2009=\u20090.86; 95% CI\u2009=\u20090.63\u20131.19; p\u2009=\u20090.37). Findings suggest that syndemic pathways to sexual risk are similar for TMSM who have socially gender affirmed as for cisgender MSM. Integration of syndemics and gender affirmation frameworks is recommended in interventions to address TMSM sexual risk.<\/jats:p>","DOI":"10.1177\/0956462415602418","type":"journal-article","created":{"date-parts":[[2015,9,18]],"date-time":"2015-09-18T23:08:06Z","timestamp":1442617686000},"page":"955-966","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":100,"title":["Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males"],"prefix":"10.1177","volume":"27","author":[{"given":"Sari L","family":"Reisner","sequence":"first","affiliation":[{"name":"Division of General Pediatrics, Boston Children\u2019s Hospital\/Harvard Medical School, Boston, MA, USA"},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA"},{"name":"The Fenway Institute, Fenway Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaclyn M","family":"White Hughto","sequence":"additional","affiliation":[{"name":"The Fenway Institute, Fenway Health, Boston, MA, USA"},{"name":"Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Pardee","sequence":"additional","affiliation":[{"name":"The Fenway Institute, Fenway Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae","family":"Sevelius","sequence":"additional","affiliation":[{"name":"Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2016,7,11]]},"reference":[{"key":"bibr1-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1080\/19540120512331325680"},{"key":"bibr2-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-009-9489-3"},{"key":"bibr3-0956462415602418","first-page":"398","volume":"20","author":"Sevelius J","year":"2009","journal-title":"Am Psychiatr Nurses Assoc"},{"key":"bibr4-0956462415602418","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.91.6.915"},{"key":"bibr5-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2010.0059"},{"key":"bibr6-0956462415602418","volume-title":"Getting primed: informing HIV prevention with gay\/bi\/queer trans men in Ontario","author":"Adams A","year":"2008"},{"key":"bibr7-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-292"},{"key":"bibr8-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1080\/15532739.2013.791650"},{"key":"bibr9-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1177\/00333549081230S313"},{"key":"bibr10-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1089\/lgbt.2015.0001"},{"key":"bibr11-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-007-9299-3"},{"key":"bibr12-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1300\/J485v08n02_11"},{"key":"bibr13-0956462415602418","doi-asserted-by":"crossref","unstructured":"Reisner SL and Murchison G. A global research synthesis of HIV and STI biobehavioral risks among female-to-male (FTM) transgender adults.\n                      Glob Public Health\n                      2016. Epub ahead of print 20 January. DOI: 10.1080\/17441692.2015.1134613.","DOI":"10.1080\/17441692.2015.1134613"},{"key":"bibr14-0956462415602418","unstructured":"Centers for Disease Control and Prevention.\n                      HIV Surveillance Report, 2013\n                      ; vol. 25. http:\/\/www.cdc.gov\/hiv\/library\/reports\/surveillance (February 2015, accessed 4 August 2015)."},{"key":"bibr15-0956462415602418","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.93.6.939"},{"key":"bibr16-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1007\/BF02879919"},{"key":"bibr17-0956462415602418","doi-asserted-by":"crossref","unstructured":"Mimiaga MJ, O'Cleirigh C, Biello KB, et\u00a0al. The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men.\n                      JAIDS\n                      2014.","DOI":"10.1097\/QAI.0000000000000475"},{"key":"bibr18-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(94)90205-4"},{"key":"bibr19-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000491"},{"key":"bibr20-0956462415602418","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2011.300284"},{"key":"bibr21-0956462415602418","first-page":"340","volume":"51","author":"Mimiaga MJ","year":"2009","journal-title":"JAIDS"},{"key":"bibr22-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1177\/1078390313500693"},{"key":"bibr23-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1007\/s11199-012-0216-5"},{"key":"bibr24-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1080\/00224499.2014.893553"},{"key":"bibr25-0956462415602418","unstructured":"Reisner S, White J, Dunham E, et\u00a0al.\n                      Discrimination and health in Massachusetts: a statewide survey of transgender and gender nonconforming adults\n                      . Boston, MA: Fenway Health, 2014."},{"key":"bibr26-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-1224"},{"key":"bibr27-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1037\/0021-843X.112.4.545"},{"key":"bibr28-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwp425"},{"key":"bibr29-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1089\/lgbt.2013.0018"},{"key":"bibr30-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1080\/10629360600810434"},{"key":"bibr31-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1177\/0962280206074463"},{"key":"bibr32-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.129.5.674"},{"key":"bibr33-0956462415602418","doi-asserted-by":"publisher","DOI":"10.2307\/2137286"},{"key":"bibr34-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-014-9896-1"},{"key":"bibr35-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-008-9405-2"},{"key":"bibr36-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1300\/J082v44n01_01"},{"key":"bibr37-0956462415602418","doi-asserted-by":"publisher","DOI":"10.1300\/J082v53n03_02"}],"container-title":["International Journal of STD &amp; AIDS"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0956462415602418","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0956462415602418","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0956462415602418","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T22:35:27Z","timestamp":1777674927000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0956462415602418"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7,11]]},"references-count":37,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2016,10]]}},"alternative-id":["10.1177\/0956462415602418"],"URL":"https:\/\/doi.org\/10.1177\/0956462415602418","relation":{},"ISSN":["0956-4624","1758-1052"],"issn-type":[{"value":"0956-4624","type":"print"},{"value":"1758-1052","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,11]]}}}