Little is known about how HIV risk varies among trans women of different ages. From January 2010 to February 2021, 2,242 trans women were assessed via outreach encounters consisting of health education and risk reduction information, and queries of recent sexual behaviors. Generalized linear models provide adjusted rates of engagement in condomless anal intercourse (CAI), in exchange sex, and CAI with exchange partners in the past 30 days for each year from age 18 to 60. Most participants identified as Hispanic/Latina (52%) and most were HIV negative (80%). Engagement in exchange sex remained prevalent from participants' early 20s through their mid-40s, though CAI with such partners never exceeded an average estimated prevalence of 15%. Condomless behaviors with non-exchange partners was more common, with at least 20% reporting engagement in non-exchange CAI regardless of age. The need for trans-specific sexual risk reduction interventions that take age into account is underscored.
Keywords: HIV; age; condomless anal intercourse; sex work; sexual risk behaviors; transgender.