A Quantitative Intersectionality Analysis of HIV/STI Prevention and Healthcare Access Among Transgender and Nonbinary People.
A Quantitative Intersectionality Analysis of HIV/STI Prevention and Healthcare Access Among Transgender and Nonbinary People.
复制标题
跨性别者和非二元人群中艾滋病毒/性传播感染预防和医疗保健获取的定量交叉分析。
DOI：
10.1097/ede.0000000000001669
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
SeattleTransandNon-binarySexualHealth(STARS)AdvisoryBoard
中科院分区：
文献类型：
--
作者：
Tordoff,DianaM;Fernandez,Atlas;Perry,NicoleLynn;Heberling,WilliamB;Minalga,Brian;Khosropour,ChristineM;Glick,SaraN;Barbee,LindleyA;Duerr,Ann;SeattleTransandNon-binarySexualHealth(STARS)AdvisoryBoard
背景：由于结构性不平等，跨性别和非二元人群在获得医疗保健方面面临巨大障碍，包括预防艾滋病毒和其他性传播感染（HIV/STI）。我们研究了不同的保险，艾滋病毒/性传播感染的患病率，测试，并使用暴露前预防措施之间的跨性别和nonbinary人生活在华盛顿州的种族和民族和gender.Methods：我们汇总了数据从五个2019-2021年华盛顿国家艾滋病毒/性传播感染监测数据来源，以获得一个大的和多样化的样本1648跨性别和nonbinary参与者。我们计算了每个结果的风险差异（RD），并使用泊松回归来估计附加相互作用可归因比例（AP）的替代指标-该指标测量了在性别和种族化经验的交叉点上观察到的结果的过度患病率的比例，超出了仅从性别或种族和种族中预期的比例。某些群体，特别是少数种族/族裔变性妇女，受到艾滋病毒/性传播感染的影响尤为严重。（RD从20%到43%，AP从50%到85%），目前不太可能有保险（RD从25%到39%，AP从74%到93%）比仅基于性别或种族化经验的预期要高。我们的研究结果强调了跨性别社区内保险获得，艾滋病毒/性传播感染阳性和预防利用的异质性。我们观察到，种族/少数民族跨性别妇女中艾滋病毒/性传播感染率增加的很大一部分可归因于性别与种族和民族的交叉。我们的研究结果强调了跨性别包容性的艾滋病毒/性传播感染预防模式的重要性，这些模式解决了植根于男权主义和结构性种族主义的多层次障碍。
Background:Transgender and nonbinary people experience substantial barriers to accessing healthcare, including prevention of HIV and other sexually transmitted infections (HIV/STI), due to structural inequities. We examined differences in insurance, HIV/STI prevalence, testing, and preexposure prophylaxis use among transgender and nonbinary people living in Washington State by race and ethnicity and gender.Methods:We pooled data from five 2019–2021 Washington State HIV/STI surveillance data sources to obtain a large and diverse sample of 1648 transgender and nonbinary participants. We calculated the risk difference (RD) for each outcome and used Poisson regression to estimate a surrogate measure of additive interaction—attributable proportion (AP)—that measures the proportion of the excess prevalence of the outcome observed at the intersection of gendered and racialized experience, beyond that expected from gender or race and ethnicity alone.Results:Participants reported overall high levels of poverty (29% incomes< $15,000 and 7% unstable housing). Certain groups, especially racial/ethnic minority transgender women, were disproportionately impacted by HIV/STIs (RDs from 20% to 43% and APs from 50% to 85%) and less likely to currently have insurance (RDs from 25% to 39% and APs from 74% to 93%) than that expected based on gendered or racialized experience alone.Conclusions:Our findings highlight the heterogeneity in insurance access, HIV/STI positivity, and prevention utilization within transgender communities. We observed that a large proportion of increased HIV/STI prevalence among racial/ethnic minority transgender women was attributable to the intersection of gender and race and ethnicity. Our findings highlight the importance of trans-inclusive models of HIV/STI prevention that address multilevel barriers rooted in cissexism and structural racism.