Introduction We explored contexts within which transgender women (TW) and men who have sex with men (MSM) practice insertive anal intercourse (AI) despite receptive role preference (receptive role strain, RRS) and receptive AI despite insertive role preference (insertive role strain, IRS).
Methods We analysed cross-sectional, egocentric data from a 2012–2014 Partner Management study in Lima, Peru. We included MSM/TW reporting an exclusive preference for receptive (pasivo) or insertive (activo) roles and AI with at least 1 of their last 3 non-female partners. Generalised estimating equations with Poisson distribution were used to assess prevalence ratios with 95% CIs for RRS and IRS during the last sexual encounter, stratified by participant sexual/gender identity. We adjusted for participant pre-sex drug use, condom use, partner type, and partner sexual orientation/role. RRS was assessed for TW and homosexual MSM, and IRS for hetero/bisexual MSM.
Results 766 MSM/TW (median age: 27, IQR: 23–32) provided data for 2,019 recent sexual partners, including: 104 TW with 286 partners, 404 homosexual-identifying MSM with 1,103 partners, and 225 hetero/bisexual-identifying MSM with 554 partners. TW reported the most strain with casual/transactional partners, homosexual MSM with primary/casual partners, and hetero/bisexual MSM with primary partners. TW predominantly (94.2%) preferred receptive roles and RRS was significantly associated with low education and pre-sex drug use (p < 0.05, references: secondary/university, no drug use). Homosexual MSM mainly (75.0%) preferred receptive roles and experienced RRS more commonly during condomless AI (p < 0.05, reference: condom-protected) with partners who preferred receptive/versatile roles (p < 0.05; reference: insertive-preferring). Conversely, 77.8% hetero/bisexual MSM preferred insertive roles and experienced IRS more commonly with insertive/versatile-preferring partners (p < 0.05) than receptive-preferring partners, while less IRS occurred with casual partners (p < 0.05; reference: stable).
Conclusion Our findings suggest different MSM/TW vulnerabilities during sexual role negotiation with partners. Future studies/interventions should consider implications for condom use agency, HIV/STI risk, and sequelae of gender dysphoria.
Disclosure of interest statement None.