Gender-based differences in non-HIV STI testing among sexually active transgender and nonbinary persons: Bridging gaps in STI research

项目摘要 研究表明，跨性别人群，一个多样化的群体， 性别认同和/或表达不同于与其性别相关的社会期望 在出生时就被贴上标签的非艾滋病毒性传播感染的比例很高。未经处理的非 艾滋病毒性传播感染可能导致负面的健康结果和社区传播。因此，我们认为， 获得非艾滋病毒性传播感染检测对降低发病率和促进公众健康至关重要。 健康在已发表的关于变性人非艾滋病毒性传播感染检测的研究中， 对人口的关注有限（几乎完全是跨性别女性）。值得注意的是， 人（不完全确定为男性或女性的人），尽管这一群体包括 在美国，1/3的跨性别者很少有文献研究非跨性别者的性别差异。 在跨性别和非二元性别人群中进行艾滋病毒性传播感染检测。此外，信息差距也 关于在TNB人群中进行非艾滋病毒性传播感染检测的障碍和促进因素， 这些障碍和促进因素可能因性别而异。为了弥补这些差距，我们的团队将研究 性活跃的TNB人群是否具有基于性别的差异（跨性别）， 妇女/跨性别男子/非二元人群）的非艾滋病毒性传播感染检测率和障碍， 非艾滋病毒性传播感染检测的促进者。我们将进行一个解释性的顺序混合方法 使用2018年密歇根州跨健康调查（MTHS）的二级定量数据进行的研究 以及使用在线焦点小组对TNB人员进行的初步定性研究。首先，我们将确定 a）终生非艾滋病毒性传播感染检测史（从未、曾经）和B） 性活跃人群自上次非艾滋病毒性传播感染检测以来的时间（从未、过去一年、1-5年、>5年） TNB的人。然后，通过社会生态学的综合概念框架， 少数民族的压力，和性别的肯定，我们将研究是否个人（例如，种族/民族）， 医疗（例如，激素疗法）;社交（例如，基于性别认同的供应商歧视）; 和结构（例如，临床性别确认）因素与终身非 艾滋病毒性传播感染检测史，以及性别认同是否会调节 非HIV STI检测史和统计学显著相关的自变量。最后， 我们将收集和分析TNB人员的主要定性数据，以进一步了解他们的 非艾滋病毒性传播感染检测的障碍和促进因素。这项研究将为未来的研究提供信息， 制定、评估和实施增加非艾滋病毒性传播感染检测的干预措施 在TNB人群中，填补了专门针对被忽视的需求的研究的关键空白， 变性人和非二元性人的群体。

PROJECT ABSTRACT Research suggests that transgender (trans) populations, a diverse group of persons whose gender identity and/or expression differ from societal expectations associated with their sex labelled at-birth, have high rates of non-HIV sexually transmitted infections (STIs). Untreated non- HIV STIs can contribute to negative health outcomes and community transmission. Therefore, access to non-HIV STI testing is of critical importance to mitigate morbidity and promote public health. Of the published research focused on non-HIV STI testing among trans people, studies are limited in population focus (almost exclusively trans women). Notably absent are nonbinary persons (those who do not identify exclusively as men or women), though this group comprises 1/3 of all trans people in the U.S. Scant literature has examined gender-based differences in non- HIV STI testing among trans and nonbinary (TNB) populations. Moreover, information gaps also exist regarding barriers and facilitators to non-HIV STI testing among TNB populations, and how these barriers and facilitators may differ by gender. To address these gaps, our team will examine whether sexually active TNB populations are characterized by gender-based differences (trans women/trans men/nonbinary people) in their rates of non-HIV STI testing and barriers and facilitators to non-HIV STI testing. We will conduct an explanatory sequential mixed-methods study using secondary quantitative data from the 2018 Michigan Trans Health Survey (MTHS) and a primary qualitative study of TNB persons using online focus groups. First, we will determine gender-based differences in a) rates of lifetime non-HIV STI testing history (never, ever) and b) time since last non-HIV STI test (never, past year, 1-5 years, >5 years) among sexually active TNB persons. Then, informed by an integrated conceptual framework drawing on social ecology, minority stress, and gender affirmation, we will examine whether individual (e.g., race/ethnicity), medical (e.g., hormone therapy); social (e.g., provider discrimination based on gender identity); and structural (e.g., clinic gender affirmation) factors are uniquely associated with lifetime non- HIV STI testing history, and whether gender identity moderates the association between lifetime non-HIV STI testing history and statistically significantly associated independent variables. Finally, we will collect and analyze primary qualitative data from TNB persons to further understand their barriers and facilitators to non-HIV STI testing. This study will inform future research focused on developing, evaluating, and implementing interventions which increase non-HIV STI testing among TNB populations, filling critical gaps in research specifically to the needs of overlooked groups of trans men and nonbinary people.