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The HIV Prevention Trials Network (HPTN) 075 study evaluated the feasibility of enrolling and retaining men who have sex with men (MSM) and transgender women (TWG) from Kenya, Malawi, and South Africa. Twenty-one participants acquired HIV during study follow-up (seroconverters). We analyzed HIV subtype diversity, drug resistance, transmission dynamics, and HIV superinfection among MSM and TGW enrolled in HPTN 075. HIV genotyping and drug resistance testing was performed for HIV-positive participants who had viral loads 400 copies/mL at