Psychosocial and sexual factors associated with recent sexual health clinic attendance and HIV testing among trans people in the UK

Hibbert, Matthew Peter; Wolton, Aedan; Weeks, Harri; Ross, M W; Brett, Clare; Porcellato, Lorna; Hope, Vivian

doi:10.1136/bmjsrh-2019-200375

Cited by 21 publications

(33 citation statements)

References 25 publications

(31 reference statements)

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“…The primacy of these issues suggest generic HIV testing services are neither accessible nor appropriately tailored for trans people in England and Wales, including those services that advertise as LGBT inclusive. These findings are consistent with research from the UK and other settings [ 5 , [7] , [8] , [9] , [10] ]. It should be noted that services designed specifically for trans people were very highly valued.…”

Section: Discussionsupporting

confidence: 91%

“…Trans women are also disproportionately represented in sex work, leading to additional sexual health needs which may be poorly met by existing services [11]. HIV testing rates among trans people in the UK are sub-optimal, with 49% of 500 trans participants reporting no lifetime HIV testing in a recent study [5].…”

Section: Introductionmentioning

confidence: 99%

“…Trans people and in particular trans women are a key population at increased risk of HIV acquisition, yet are severely underserved in the global response, including in HIV prevention and testing research [ 2 , 3 ]. There is also a lack of data on the sexual health needs of trans men and women in the UK, despite the fact that this group is more likely to be diagnosed with HIV late, less likely to attend sexual health clinics and less likely to test for HIV than cisgender men who have sex with men (MSM) [4] , [5] , [6] .…”

Section: Introductionmentioning

confidence: 99%

“…Trans people globally face barriers to HIV testing and prevention services not experienced by other groups [7] . These barriers include services which are not culturally appropriate, health care provider hostility and lack of understanding, the risk of arrest and imprisonment and barriers surrounding trans visibility and associated vulnerability [ 5 , 7 – 10 ]. Trans women are also disproportionately represented in sex work, leading to additional sexual health needs which may be poorly met by existing services [11] .…”

Section: Introductionmentioning

confidence: 99%

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Impact and acceptability of HIV self-testing for trans men and trans women: A mixed-methods subgroup analysis of the SELPHI randomised controlled trial and process evaluation in England and Wales

et al. 2021

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Background: Globally, trans people are disproportionately affected by HIV, but research on strategies to increase testing are limited. SELPHI is a randomised-controlled-trial (RCT) of 10,135 cis men, trans men, and trans women reporting lifetime anal intercourse with male partners (cis or trans), evaluating whether the offer of free HIV self-testing (HIVST) increases diagnosis. This subgroup analysis from the SELPHI RCT aims to describe key HIVST outcomes and HIVST acceptability for trans people. Methods: SELPHI recruited using social networking and trans focused social media. Participants were randomised 60/40 to baseline HIVST (Biosure TM) (BT) vs no baseline HIVST (nBT); and at 3-months (if completed the survey and reported recent CAI) 50/50 to 3-monthly HIVST (RT) vs no repeat HIVST (nRT). Outcomes were self-reported through online surveys. We conducted a qualitative study of semi-structured peer-led participant interviews (n = 20) exploring HIVST motivations and experiences. These were analysed using a framework approach. Findings: SELPHI recruited and randomised 118 trans men and trans women (94 trans men, 24 trans women), of whom 20 (16 trans men, 4 trans women) underwent the second randomisation. Median age at baseline was 29 (IQR: 22, 37), 79% were white, 79% were UK born, 37% had degree level education, and 31% had never tested for HIV. 62% (n = 59) of trans men completed the 3-month survey, but survey completion by trans women in nBT was too low (1/11) for randomised comparison. In trans men HIV testing uptake by 3 months was significantly higher in BT (95% 36/38) vs nBT (29%, 6/21) (RR=3.32 (1.68, 6.55) p<0.001). Trans people randomised to RT reported 3 times higher rate of HIV testing compared to nRT during the two-year followup (IRR 3.66 (1.86, 8.01) p<0.0001). STI testing frequency (mean number of tests during each 13 week period/ 2-year follow-up) was not significantly different across interventions: RT (0.03) and nRT (0.01) (IRR=1.86 95%CI; 0.77, 5.15; p = 0.15). Social harms were rare. Acceptability was very high in BT: 97% (38/39) found instructions easy to understand, 97% (37/38) found the HIVST simple to use and 100% (39/39) reported good overall experience. In interviews, reported HIVST benefits included increased autonomy, privacy, convenience and avoidance of health care providers perceived to be discriminatory and services that increased dysphoria. Minor lancet and test processing issues were reported. Interpretation: HIVST significantly increased testing uptake and frequency in trans men and trans people overall, although recruitment and retention of trans women was low. HIVST acceptability was high and indicates easy access to this novel technology may increase HIV testing access for this key population.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact and acceptability of HIV self-testing for trans men and trans women: A mixed-methods subgroup analysis of the SELPHI randomised controlled trial and process evaluation in England and Wales

et al. 2021

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“…Whilst ve trials of YMSM were identi ed, none were found that focused on other LGBTQI + groups. There is a notable dearth of interventions for this group (excluding YMSM/MSM), particularly for trans youth (64).…”

Section: Discussionmentioning

confidence: 99%

Improving the sexual health of young people (under 25) in high-risk populations: a systematic review and meta-analysis of behavioural and psychosocial interventions.

Brown¹,

Monaco²,

O’Donoghue³

et al. 2021

Preprint

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Background Ensuring young people experience good sexual health is a key public health concern. Yet, some vulnerable groups of young people are at higher risk of poor sexual health, and consequently require additional support to achieve good sexual health. Therefore, the aim of this systematic review was to identify and assess the evidence base for behavioural and psychosocial interventions to improve sexual health for young people with additional vulnerabilities.Methods We searched for randomised controlled trials of interventions aimed at promoting sexual health, with any non-pharmacological comparator (e.g., waitlist control). Key outcomes of interest were indicators of sexual health (e.g., condom use, attitudes to contraception, knowledge of risk). Participants in eligible trials were under 25 years old and in a high-risk group (alcohol and other drug use; justice-involved; homeless; LGBTQI+; mental ill-health; ethnic minority, or out-of-home care). The final literature searches were performed on 16 September 2020, on MEDLINE, PsycINFO, EMBASE, CENTRAL, Web of Science, Scopus and clinical trial registries. Meta-analyses were conducted where possible.Results Forty-seven papers from 46 trials of the 5213 identified met inclusion criteria, with all but one of the included trials conducted in North America. Three focused predominantly on AOD, six on juvenile justice, two on homelessness, five on young men who have sex with men (YMSM), 26 on ethnic minorities, two on mental ill-health, three on out-of-home care, however no trials were identified in LGBTQI + groups outside of YMSM. The 47 included papers had a combined total of 21,543 participants. The vast majority (26/46) of trials were conducted with ethnic minority groups, with most of the interventions delivered as group therapy, and some involving parents and caregivers. Condom use was the most frequently reported outcome measure. In trials targeting ethnic minorities, the meta-analysis found a medium effect size (0.62, p = 0.0004) of the intervention on condom use.Conclusions There remains a dearth of research undertaken outside of North America, and in high-risk groups other than ethnic minorities. Future interventions should address sexual health more broadly than just the absence of negative biological outcomes with LGBTQI+, homeless and mental ill-health populations targeted for such work.This review was registered at Prospero (ref. 149810) and at osf.io/ukva9.

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Addressing Unhealthy Alcohol Use and the HIV Pre-exposure Prophylaxis Care Continuum in Primary Care: A Scoping Review

Oldfield

Edelman

2020

AIDS Behav

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Psychosocial and sexual factors associated with recent sexual health clinic attendance and HIV testing among trans people in the UK

Cited by 21 publications

References 25 publications

Impact and acceptability of HIV self-testing for trans men and trans women: A mixed-methods subgroup analysis of the SELPHI randomised controlled trial and process evaluation in England and Wales

Impact and acceptability of HIV self-testing for trans men and trans women: A mixed-methods subgroup analysis of the SELPHI randomised controlled trial and process evaluation in England and Wales

Improving the sexual health of young people (under 25) in high-risk populations: a systematic review and meta-analysis of behavioural and psychosocial interventions.

Addressing Unhealthy Alcohol Use and the HIV Pre-exposure Prophylaxis Care Continuum in Primary Care: A Scoping Review

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