Fehrenbacher Anne E, Cain Demetria, Rusow Joshua A, Lakshmanan Swetha, Polanco Dianna, Ward Demi, Tapia Yara, Flynn Risa P, Sullivan Patrick S, Comulada W Scott, Horvath Keith J, Reback Cathy J, Swendeman Dallas T
Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Psychology, Hunter College, City University of New York, New York, NY, USA.
AIDS Behav. 2025 Apr;29(4):1136-1157. doi: 10.1007/s10461-024-04590-x. Epub 2025 Jan 31.
This study assessed disparities in pre-exposure prophylaxis (PrEP) use among transgender and gender expansive youth and young adults (N = 477) between 15 and 24 years old in the CARES (ATN 149) and TechStep (ATN 160) study protocols within the National Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Structural equation modeling was used to test mediation pathways between gender identity and PrEP uptake among the full sample and stratified by sex assigned at birth. Lifetime PrEP uptake was higher among those assigned male at birth (26%) versus assigned female at birth (9%), explained by greater structural and behavioral risks and perceived need for PrEP, especially among trans women. Among those assigned female at birth, PrEP uptake was higher among trans men (12%) than nonbinary participants (6%). Our findings characterize key structural and behavioral drivers of PrEP use and highlight the need to reduce barriers to healthcare for trans youth, particularly in the South.
本研究评估了在国家青少年医学艾滋病干预试验网络（ATN）的CARES（ATN 149）和TechStep（ATN 160）研究方案中，15至24岁的跨性别及性别认同扩展的青少年和年轻人（N = 477）在暴露前预防（PrEP）使用方面的差异。采用结构方程模型来检验整个样本以及按出生时指定性别分层后的性别认同与PrEP使用之间的中介途径。出生时被指定为男性的人群中，终生PrEP使用率较高（26%），而出生时被指定为女性的人群中该使用率为9%，这可以通过更大的结构和行为风险以及对PrEP的感知需求来解释，尤其是在跨性别女性中。在出生时被指定为女性的人群中，跨性别男性的PrEP使用率（12%）高于非二元性别参与者（6%）。我们的研究结果描述了PrEP使用的关键结构和行为驱动因素，并强调需要减少跨性别青少年获得医疗保健的障碍，尤其是在南方地区。
