School of Social Work, University of Michigan, Ann Arbor, Michigan, USA.
School of Social Work, Michigan State University, East Lansing, Michigan, USA.
J Int AIDS Soc. 2022 Oct;25 Suppl 5(Suppl 5):e25972. doi: 10.1002/jia2.25972.
Transgender (trans) and nonbinary people (TNB) are disproportionately impacted by HIV. HIV testing is critical to engage TNB people in HIV prevention and care. Yet, scant literature has examined social and structural factors associated with HIV testing among TNB people of diverse genders and in geographies with potentially lower trans acceptance. We: (1) characterized the prevalence of never having been tested for HIV; and (2) identified associated factors, among TNB people in Michigan, United States.
Data were from a community-based participatory cross-sectional survey (n = 539 sexually experienced TNB people). The prevalence of never having had an HIV test was reported overall and compared across socio-demographic, clinical, social and structural factors using bivariable and multivariable logistic regression analyses.
Approximately one-quarter (26.2%) of participants had never had an HIV test (20.8% transfeminine; 30.0% transmasculine; 17.8% nonbinary assigned male at-birth; and 32.0% nonbinary assigned female at-birth). In a multivariable socio-demographic model, older age (adjusted odds ratio [aOR] for 1-year increase: 0.93, 95% CI: 0.90, 0.96, p<0.001) and Black/African American race (vs. White) (aOR: 0.28, 95% CI: 0.09, 0.86, p<0.05) were associated with increased odds of HIV testing (aORs for never testing). In separate multivariable models controlling for socio-demographics, ever experiencing sexual violence (aOR: 0.38, 95% CI: 0.21, 0.67, p<0.001), not accessed sexual/reproductive healthcare in the past 12 months (aOR: 4.46, 95% CI: 2.68, 7.43, p<0.001) and reporting a very/somewhat inclusive primary care provider (PCP) (aOR: 0.29, 95% CI: 0.17, 0.49, p<0.001) were associated with HIV testing (aORs for never testing).
Findings contribute to scant literature about gender-based differences in HIV testing inclusive of transmasculine and nonbinary people. Lack of statistically significant gender differences suggests that broad TNB interventions may be warranted. These could include training healthcare providers in trans-inclusive practices with sexual violence survivors and PCPs in trans-inclusive HIV prevention and care. Findings showing Black participants were less likely to have never had an HIV test suggest the promise of culturally tailored services, though further investigation is needed. Findings identify social and structural factors associated with HIV testing and can inform multi-level interventions to increase TNB person's HIV testing.
跨性别者（trans）和非二元性别者（TNB）受到 HIV 的不成比例影响。HIV 检测对于让 TNB 人群参与 HIV 预防和护理至关重要。然而，几乎没有文献研究过与不同性别和在潜在接受度较低的跨性别者地区的 TNB 人群的 HIV 检测相关的社会和结构因素。我们：（1）描述密歇根州 TNB 人群中从未接受过 HIV 检测的比例；（2）确定了相关因素。
数据来自基于社区的参与性横断面调查（n = 539 名有性经验的 TNB 人群）。报告了从未接受过 HIV 检测的比例，总体上并根据社会人口统计学、临床、社会和结构因素进行了比较，使用了双变量和多变量逻辑回归分析。
大约四分之一（26.2%）的参与者从未接受过 HIV 检测（20.8%的跨女性；30.0%的跨男性；17.8%的出生时被分配为男性的非二元性别；32.0%的出生时被分配为女性的非二元性别）。在多变量社会人口统计学模型中，年龄较大（每增加 1 年的调整后优势比 [aOR]：0.93，95%CI：0.90，0.96，p < 0.001）和黑/非裔美国人种族（与白人相比）（aOR：0.28，95%CI：0.09，0.86，p < 0.05）与 HIV 检测的可能性增加相关（从未检测的 aOR）。在单独的多变量模型中，控制了社会人口统计学因素，曾经经历过性暴力（aOR：0.38，95%CI：0.21，0.67，p < 0.001），过去 12 个月未接受过性/生殖保健（aOR：4.46，95%CI：2.68，7.43，p < 0.001）和报告非常/有点包容的初级保健提供者（PCP）（aOR：0.29，95%CI：0.17，0.49，p < 0.001）与 HIV 检测相关（从未检测的 aOR）。
研究结果有助于了解包括跨男性和非二元性别者在内的基于性别的 HIV 检测差异方面的文献。缺乏统计学上显著的性别差异表明，可能需要广泛的 TNB 干预措施。这些措施可以包括培训医疗保健提供者，使其具备对性暴力幸存者和 PCP 进行跨性别包容的实践，以及对跨性别包容的 HIV 预防和护理进行培训。研究结果表明，黑人参与者不太可能从未接受过 HIV 检测，这表明有必要提供文化上量身定制的服务，但还需要进一步调查。研究结果确定了与 HIV 检测相关的社会和结构因素，并可以为增加 TNB 人群的 HIV 检测提供多层面的干预措施。
