HIV testing among transgender and nonbinary persons in Michigan, United States: results of a community-based survey.
HIV testing among transgender and nonbinary persons in Michigan, United States: results of a community-based survey.
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DOI：
10.1002/jia2.25972
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发表时间：
2022-10
影响因子：
6
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跨性别者（trans）和非二元性别者（TNB）受到艾滋病毒的影响不成比例。艾滋病毒检测对于使TNB人群参与艾滋病毒预防和护理至关重要。然而，很少有文献研究了在不同性别和跨性别接受度可能较低的地区的TNB人群中进行艾滋病毒检测的社会和结构因素。我们：(1)描述了从未接受过艾滋病毒检测的流行程度；(2)在美国密歇根州TNB人群中确定相关因素。数据来自一项基于社区的参与性横断面调查（n = 539名有过性经验的TNB人群）。使用双变量和多变量logistic回归分析，报告了总体上从未接受过艾滋病毒检测的流行率，并对社会人口统计学、临床、社会和结构因素进行了比较。大约四分之一（26.2%）的参与者从未进行过艾滋病毒检测（20.8%为跨性别者；30.0%为跨男性者；17.8%为非二元性别出生的男性；32.0%为非二元性别出生的女性）。在多变量社会人口统计学模型中，年龄较大（1年校正比值比[aOR]增加：0.93,95% CI: 0.90, 0.96, p<0.001）和黑人/非裔美国人种族（与白人相比）（aOR: 0.28, 95% CI: 0.09, 0.86, p<0.05）与HIV检测的几率增加（从未检测的aOR）相关。在控制社会人口统计学因素的单独多变量模型中，曾经遭受过性暴力（aOR: 0.38, 95% CI: 0.21, 0.67, p<0.001）、过去12个月内未获得性/生殖保健（aOR: 4.46, 95% CI: 2.68, 7.43, p<0.001）以及报告一个非常/有些包容性的初级保健提供者（PCP） （aOR: 0.29, 95% CI: 0.17, 0.49, p<0.001）与艾滋病毒检测相关（aOR为从未检测）。研究结果对基于性别的艾滋病毒检测差异（包括跨性别和非二元性）的文献缺乏贡献。缺乏统计上显著的性别差异表明，可能需要广泛的TNB干预措施。这些措施可包括对医疗保健提供者进行跨性别包容性做法培训，对性暴力幸存者进行跨性别包容性做法培训，对pcp进行跨性别包容性艾滋病毒预防和护理培训。调查结果显示，黑人参与者从未接受过艾滋病毒检测的可能性较小，这表明有希望提供适合不同文化的服务，尽管还需要进一步的调查。研究结果确定了与艾滋病毒检测相关的社会和结构因素，并可以为多层次干预提供信息，以增加TNB患者的艾滋病毒检测。
Transgender (trans) and nonbinary people (TNB) are disproportionately impacted by HIV. HIV testing is critical to engage TNB people in HIV prevention and care. Yet, scant literature has examined social and structural factors associated with HIV testing among TNB people of diverse genders and in geographies with potentially lower trans acceptance. We: (1) characterized the prevalence of never having been tested for HIV; and (2) identified associated factors, among TNB people in Michigan, United States. Data were from a community‐based participatory cross‐sectional survey (n = 539 sexually experienced TNB people). The prevalence of never having had an HIV test was reported overall and compared across socio‐demographic, clinical, social and structural factors using bivariable and multivariable logistic regression analyses. Approximately one‐quarter (26.2%) of participants had never had an HIV test (20.8% transfeminine; 30.0% transmasculine; 17.8% nonbinary assigned male at‐birth; and 32.0% nonbinary assigned female at‐birth). In a multivariable socio‐demographic model, older age (adjusted odds ratio [aOR] for 1‐year increase: 0.93, 95% CI: 0.90, 0.96, p<0.001) and Black/African American race (vs. White) (aOR: 0.28, 95% CI: 0.09, 0.86, p<0.05) were associated with increased odds of HIV testing (aORs for never testing). In separate multivariable models controlling for socio‐demographics, ever experiencing sexual violence (aOR: 0.38, 95% CI: 0.21, 0.67, p<0.001), not accessed sexual/reproductive healthcare in the past 12 months (aOR: 4.46, 95% CI: 2.68, 7.43, p<0.001) and reporting a very/somewhat inclusive primary care provider (PCP) (aOR: 0.29, 95% CI: 0.17, 0.49, p<0.001) were associated with HIV testing (aORs for never testing). Findings contribute to scant literature about gender‐based differences in HIV testing inclusive of transmasculine and nonbinary people. Lack of statistically significant gender differences suggests that broad TNB interventions may be warranted. These could include training healthcare providers in trans‐inclusive practices with sexual violence survivors and PCPs in trans‐inclusive HIV prevention and care. Findings showing Black participants were less likely to have never had an HIV test suggest the promise of culturally tailored services, though further investigation is needed. Findings identify social and structural factors associated with HIV testing and can inform multi‐level interventions to increase TNB person's HIV testing.