Gender as an Obstacle in HIV/AIDS Prevention: Considerations for the Development of HIV/AIDS Prevention Efforts for Male-to-Female Transgenders Sheilla Rodríguez-Madera, PhD José Toro-Alfonso, PhD SUMMARY. Social discourses regarding gender are responsible for molding people’s cognitions, perceptions, behaviors, and interactions with others. Approaching and understanding gender social- ization is an important strategy that must be included in the development of HIV/AIDS prevention intervention efforts targeting male-to-female (MTF) transgender people. This paper represents an effort to identify the influence of gender construction among a group of MTF transgenders in Puerto Rico. Using combined methodology, authors examined results from a questionnaire and in-depth interviews with a convenience sample of MTF transgenders living in the San Juan metropolitan area. Quantitative analysis demonstrated that this sample is composed of young, unemployed, and undereducated population. Many participated in the sex industry. Participants reported need for basic health and social services and alienation from social networks. Qualitative analysis con- firmed their traditional social construction of the “feminine.” Their discourse underlines their need to reinforce their identity by the construction of a female self which undermines their possibilities for negotiating safer sex, as happens to most females in Latino societies. Social vulnerability, institutional exclusion, and gender construction issues are obstacles for the HIV prevention efforts among these communities. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <docdelivery@haworthpress. com> Website: <http://www.HaworthPress.com>  2005 by The Haworth Press, Inc. All rights reserved.] KEYWORDS. Sex work, prostitution, HIV/AIDS, Latino, transgender, gender ideology INTRODUCTION The transgender label encompasses all indi- viduals who defy traditional gender roles. This variety of gender identities include drag queens, androgynous, transvestites, transformers, inter- sexuals, transsexuals, and even particular fash- ion statements (American Educational Gender Sheilla Rodríguez-Madera, PhD, and José Toro-Alfonso, PhD, are both affiliated with the University Center for Psychological Research and Services, Department of Psychology, University of Puerto Rico, San Juan, PR. Address correspondence to: Sheilla Rodríguez-Madera, PhD, CUSEP/UPR, P.O. Box 23174, San Juan, PR 00931-3174 (E-mail: sheillalrm@hotmail.com). [Haworth co-indexing entry note]: “Gender as an Obstacle in HIV/AIDS Prevention: Considerations for the Development of HIV/AIDS Pre- vention Efforts for Male-to-Female Transgenders.” Rodríguez-Madera, Sheilla, and José Toro-Alfonso. Co-published simultaneously in Interna- tional Journal of Transgenderism (The Haworth Medical Press, an imprint of The Haworth Press, Inc.) Vol. 8, No. 2/3, 2005, pp. 113-122; and: Transgender Health and HIV Prevention: Needs Assessment Studies from Transgender Communities Across the United States (ed: Walter Bockting, and Eric Avery) The Haworth Medical Press, an imprint of The Haworth Press, Inc., 2005, pp. 113-122. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: docdelivery@haworthpress.com]. Available online at http://www.haworthpress.com/web/IJT  2005 by The Haworth Press, Inc. All rights reserved. doi:10.1300/J485v08n02_10 113