Laboratory-confirmed HIV and sexually transmitted infection seropositivity and risk behavior among sexually active transgender patients at an adolescent and young adult urban community health center

Abstract

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.

Partner-Level Factors Associated with Insertive and Receptive Condomless Anal Intercourse Among Transgender Women in Lima, Peru

“…Condom use patterns for RAI in our sample paralleled previous findings of a higher prevalence of overall CAI within the primary partnerships of MSM and TW in Peru [1, 27] and TW in the US [24, 26, 28, 42]. The approximation of condomless RAI to overall CAI in our analysis raises concerns that factors associated with composite CAI may be driven by our sample’s predominant sexual behavior (RAI) and therefore may mask important distinctions between specific sexual behaviors.…”

“…Studies of the male partners of TW are also needed in order to better understand the characteristics of these partners, their relationship dynamics with TW, and associated HIV/STI risks. Studies in the US have described a diversity of sexual orientations and risk behaviors among male partners of TW, which have important implications for the risk of HIV/STI transmission between TW and their partners [28, 33, 35]. However, such epidemiological characterizations of HIV/STI risk have yet to be conducted among the partners of TW in Peru.…”

“…Previous research in Peru, Brazil, Thailand, and the US has described a greater risk of condomless anal intercourse within the primary partnerships of TW compared to their casual or transactional sex partnerships [1, 21–28]. At the same time, qualitative studies with Peruvian and US TW have described a preference for receptive roles during anal intercourse with intimate male partners as a gender-affirming act [11, 19, 20], and described the practice of insertive anal intercourse as something performed predominantly as a transactional sex activity [11, 17, 21].…”

Facilitators and Barriers to Participation in PrEP HIV Prevention Trials Involving Transgender Male and Female Adolescents and Emerging Adults

“…Available data suggest that in the U.S.HIV prevalence rates for transgender female (TF) and transgender male(TM) adolescents and emerging adults who have sex with cisgender men range between 5%-22% (Brennan et al, 2012; Feldman et al, 2014; Harbarta et al, 2015; Herbst, Jacobs, Finlayson, McKleroy, Neumann, & Crepaz.,2008; Reisner et al 2015; Wilson et al, 2015). Despite the disproportionate burden of HIV facing transgender youth, they continue to be under-represented in HIV research, including studies on adherence to preexposure prophylaxis (PrEP) (Andrasik, Yoon, Mooney, Broder, Bolton, Votto et al, 2014; Galindo et al, 2012; Reisner et al, 2016; Singh, 2016).…”

“…Despite the disproportionate burden of HIV facing transgender youth, they continue to be under-represented in HIV research, including studies on adherence to preexposure prophylaxis (PrEP) (Andrasik, Yoon, Mooney, Broder, Bolton, Votto et al, 2014; Galindo et al, 2012; Reisner et al, 2016; Singh, 2016). For example, TF persons are often grouped with and under-represented in studies of cisgender men who have sex with men (Bowers et al, 2012; Escudero et al, 2014) and TM youth have been excluded from PrEP research on the erroneous assumption that their sexual relationships are nearly exclusively with cisgender women, despite an emerging literature on HIV risk among TM who have sex with men (Bauer et al, 2013; Reisner et al, 2015; Scheim et al, 2016; Wansom et al, 2016). …”