AIDS and Behavior

, Volume 23, Issue 2, pp 366–374 | Cite as

“Unspoken Agreements”: Perceived Acceptability of Couples HIV Testing and Counseling (CHTC) Among Cisgender Men with Transgender Women Partners

  • Sari L. ReisnerEmail author
  • David Menino
  • Kingsley Leung
  • Kristi E. Gamarel
Original Paper


Transgender women (TW) are one of the highest risk groups for HIV infection globally; however, the HIV testing needs of their cisgender (non-transgender) male partners remain largely unknown. This study sought to examine the perceived acceptability of couples HIV testing and counseling (CHTC) for TW-male dyads from the perspective of cisgender men who partner with TW. Between September 2016 and June 2017, 19 cisgender men (mean age = 40.1, SD = 12.8) who currently have, or have ever had a TW partner completed an in-depth semi-structured phone interview and brief survey to gather data on acceptability of CHTC, as well as perceived barriers and facilitators to CHTC for TW-male couples. Qualitative data were thematically analyzed and integrated with survey data. Acceptability of CHTC was high in the sample (89.5%) but was complex and largely contingent on: (1) monogamy and commitment as critical precursors to CHTC acceptability; (2) risk perception and level of comfort with CHTC; (3) understandings of sexual agreements; and (4) personal relationships versus other TW-male relationships. Findings have implications for culturally-adapting and implementing CHTC in real-world settings for TW-male couples, as well as for meeting the individual HIV testing needs of cisgender men who partner with TW.


Transgender women Men who partner with transgender women HIV infection Couples HIV counseling and testing (CHTC) Intervention 



This publication was supported by a developmental grant awarded to PI Dr. Reisner (CFAR-FCHC-15-1) by: (1) the Harvard University Center for AIDS Research (CFAR), an NIH funded program (P30 AI060354), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, and OAR; (2) the Harvard Global Health Institute (HGHI). The findings and conclusions in this report are those of the authors and do not necessarily represent any official position of the funders.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sari L. Reisner
    • 1
    • 2
    • 3
    Email author
  • David Menino
    • 1
  • Kingsley Leung
    • 2
  • Kristi E. Gamarel
    • 4
  1. 1.Division of General PediatricsBoston Children’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA
  3. 3.The Fenway Institute, Fenway HealthBostonUSA
  4. 4.Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborUSA

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