Reisner Sari L, Vetters Ralph, White Jaclyn M, Cohen Elijah L, LeClerc M, Zaslow Shayne, Wolfrum Sarah, Mimiaga Matthew J
a Department of Epidemiology , Harvard School of Public Health , Boston , MA , USA.
AIDS Care. 2015;27(8):1031-6. doi: 10.1080/09540121.2015.1020750. Epub 2015 Mar 19.
The sexual health of transgender adolescents and young adults who present for health care in urban community health centers is understudied. A retrospective review of electronic health record (EHR) data was conducted from 180 transgender patients aged 12-29 years seen for one or more health-care visits between 2001 and 2010 at an urban community health center serving youth in Boston, MA. Analyses were restricted to 145 sexually active transgender youth (87.3% of the sample). Laboratory-confirmed HIV and sexually transmitted infections (STIs) seroprevalence, demographics, sexual risk behavior, and structural and psychosocial risk indicators were extracted from the EHR. Analyses were descriptively focused for HIV and STIs. Stratified multivariable logistic regression models were fit for male-to-female (MTF) and female-to-male (FTM) patients separately to examine factors associated with any unprotected anal and/or vaginal sex (UAVS). The mean age was 20.0 (SD=2.9); 21.7% people of color, 46.9% white (non-Hispanic), 21.4% race/ethnicity unknown; 43.4% MTF, and 56.6% FTM; and 68.3% were on cross-sex hormones. Prevalence of STIs: 4.8% HIV, 2.8% herpes simplex virus, 2.8% syphilis, 2.1% chlamydia, 2.1% gonorrhea, 2.8% hepatitis C, 1.4% human papilloma virus. Only gonorrhea prevalence significantly differed by gender identity (MTF 2.1% vs. 0.0% FTM; p=0.046). Nearly half (47.6%) of the sample engaged in UAVS (52.4% MTF, 43.9% FTM, p=0.311). FTM more frequently had a primary sex partner compared to MTF (48.8% vs. 25.4%; p=0.004); MTF more frequently had a casual sex partner than FTM (69.8% vs. 42.7% p=0.001). In multivariable models, MTF youth who were younger in age, white non-Hispanic, and reported a primary sex partner had increased odds of UAVS; whereas, FTM youth reporting a casual sex partner and current alcohol use had increased odds of UAVS (all p<0.05). Factors associated with sexual risk differ for MTF and FTM youth. Partner type appears pivotal to understanding sexual risk in transgender adolescents and young adults. HIV and STI prevention efforts, including early intervention efforts, are needed in community-based settings serving transgender youth that attend to sex-specific (biological) and gender-related (social) pathways.
在城市社区健康中心接受医疗保健服务的跨性别青少年和青年的性健康情况尚未得到充分研究。对2001年至2010年间在马萨诸塞州波士顿一家为青少年服务的城市社区健康中心接受过一次或多次医疗保健就诊的180名年龄在12至29岁之间的跨性别患者的电子健康记录（EHR）数据进行了回顾性分析。分析仅限于145名有性活动的跨性别青少年（占样本的87.3%）。从电子健康记录中提取了实验室确诊的艾滋病毒和性传播感染（STIs）血清流行率、人口统计学特征、性风险行为以及结构和心理社会风险指标。分析主要针对艾滋病毒和性传播感染进行描述性研究。分别为男变女（MTF）和女变男（FTM）患者拟合分层多变量逻辑回归模型，以检查与任何无保护肛交和/或阴道性交（UAVS）相关的因素。平均年龄为20.0岁（标准差=2.9）；21.7%为有色人种，46.9%为白人（非西班牙裔），21.4%种族/族裔未知；43.4%为MTF，56.6%为FTM；68.3%正在使用跨性别激素。性传播感染的患病率：艾滋病毒4.8%，单纯疱疹病毒2.8%，梅毒2.8%，衣原体2.1%，淋病2.1%，丙型肝炎2.8%，人乳头瘤病毒1.4%。只有淋病患病率在性别认同方面存在显著差异（MTF为2.1%，FTM为0.0%；p=0.046）。近一半（47.6%）的样本有过无保护肛交和/或阴道性交（MTF为52.4%，FTM为43.9%，p=0.311）。与MTF相比，FTM更频繁地有固定性伴侣（48.8%对25.4%；p=0.004）；MTF比FTM更频繁地有临时性伴侣（69.8%对42.7%，p=0.001）。在多变量模型中，年龄较小、为非西班牙裔白人且有固定性伴侣的MTF青少年进行无保护肛交和/或阴道性交的几率增加；而报告有临时性伴侣且当前饮酒的FTM青少年进行无保护肛交和/或阴道性交的几率增加（所有p<0.05）。MTF和FTM青少年与性风险相关的因素不同。伴侣类型似乎是理解跨性别青少年和青年性风险的关键。在为跨性别青少年服务的社区环境中，需要开展艾滋病毒和性传播感染预防工作，包括早期干预工作，同时要关注特定性别（生物学）和与性别相关（社会）的途径。
