Likelihood of HIV and recent bacterial sexually transmitted infections among transgender and non-binary individuals in 20 European countries, October 2023 to April 2024

Abstract

Background Global data highlight the disproportionate burden of HIV and sexually transmitted infections (STIs) among transgender individuals. However, scant data exist for both transgender and non-binary individuals in European HIV/STI surveillance. Aim To assess self-reported prevalence of HIV and bacterial STIs (syphilis, gonorrhoea, chlamydia) in the past 6 months among transgender and non-binary individuals, comparing the likelihoods of recent STIs between groups. Methods Using data from the cross-sectional PROTECT survey conducted in 20 European countries from October 2023 to April 2024, we analysed a subset of 452 participants, 178 transgender and 274 non-binary individuals. Logistic regression was used to compare the risk of each recent bacterial STI, and Poisson regression to compare the risk of the number of recent STIs. Results Among transgender individuals, 5 (2.8%) self-reported HIV infection, and recent STI prevalence was 6.7% for syphilis, 15.6% for gonorrhoea and 19.6% for chlamydia. For non-binary individuals, 15 (5.5%) self-reported HIV infection and recent STI prevalence was 15.0% for syphilis, 18.7% for gonorrhoea and 20.8% for chlamydia. Non-binary individuals had significantly higher risk for syphilis (aOR: 1.81; 95% CI: 1.01–4.05) and multiple recent STIs (aOR: 1.46; 95% CI: 1.11–1.91) compared with transgender individuals. Conclusion While both transgender and non-binary individuals showed high self-reported prevalence of HIV and bacterial STIs, non-binary individuals showed greater prevalence of STIs, particularly syphilis. Efforts aimed at HIV/STI prevention and surveillance should encourage inclusion of those who identify as non-binary and other gender-diverse individuals alongside transgender individuals to enhance the provision of tailored prevention and treatment services in Europe.