Unprotected anal intercourse is, of course, a known high-risk sexual activity. Transgendered persons often feel shame, disgust, and guilt because of their desire to function as members of the other sex. This can undermine decision-making, and thus be a significant factor in transmission of the HIV virus. The individual who prefers to think of her anus as a vagina, and the individual who does not carry protection because she believes that it will prevent her from succumbing to temptation, as well as the sexually naive crossdressed individual who is aggressively approached and seduced may find themselves engaging in high-risk sexual activities without protection. Without a source for support and education, the behavior may occur throughout a long period of time, increasing the risk of infection.
Violence Transgendered individuals can enrage others by their mere existence.
If appearance is androgynous or gives mixed gender signals, they become likely targets for gay-bashing. Additionally, sometimes sexual partners do not know that the woman they picked up is has a male anatomy, and can become violent when they do discover it. For whatever reason, there is an astounding amount of violence done to transgendered persons, much of which is not reported because of shame or internalized transphobia. That which is reported is often either not listed as a hate crime, or, if it is, is listed as violence against a gay male rather than to a transgendered person. The extent of this violence should not be underestimated.