Background The male-to-female-transgender persons recently registered the highest percentage of new Human Immunodeficiency Virus (HIV) cases nationwide as they entered the world's oldest profession and the country's fourth largest contributor to the Gross National Product – prostitution.

Objectives This qualitative study aimed to explore the sexual practices among MTFT persons in prostitution which made them vulnerable to HIV transmission.

Methods Using narratives as an approach and Balan's Grid by Tagg (1985) to provide a structure for constructing and making sense out of life stories, five (5) MTFT persons in prostitution from Davao City, at least 19 years old with unknown HIV status, from various socio-economic backgrounds were purposively chosen as narrators. Guided by Helsinki principles, informed consent was obtained to answer two research questions: “What are your sexual practices as MTFT in prostitution? How do these sexual practices affect you as MTFT? The proposition of the study was “MTFT person who lack knowledge on HIV and condom negotiation skills tend to engage in unprotected anal sex”.

Result The conceptual framework is based on motivation as affected by psychosocial factors. Findings revealed that lack of education and work opportunity forced MTFT persons to engage in prostitution to earn a living for their families. Physical and sexual assault (performing sex against their will and not being paid) from patrons and at times police were also reported. Failure to negotiate for condom use to grant client's request, unavailability of condoms and substance abuse exposed MTFT to sexually transmitted infections. Sexual adventurism, promiscuity – along with anxiety and depression which led to suicide attempts – were attributed to traumatic effects of childhood neglect, physical and sexual abuse and emerged as common themes.

Conclusion More scientific inquiry and theory-based studies should be made to come up with MTFT-focused behavioral modification strategies that could lead to effective HIV intervention policies and programs.