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，变性人是一个多元化的群体，他们的 性别认同和/或表达不同于与其性别相关的社会期望 在出生时被贴上标签的儿童，非艾滋病毒性传播感染(STI)的比率很高。未经处理的非- 艾滋病毒/性传播疾病可能会造成负面的健康后果和社区传播。因此， 获得非艾滋病毒性传播感染检测对于减少发病率和促进公众 健康。发表的研究集中在跨性别者中的非HIV STI检测，研究 人口集中程度有限(几乎全是跨性妇女)。值得注意的是，不存在非二进制 人(那些不完全是男性或女性的人)，尽管这一群体包括 在美国三分之一的跨性别者中，很少有文献研究过基于性别的非 在反式和非二进制(TNB)人群中进行HIV STI检测。此外，信息鸿沟也 关于在TNB人群中进行非艾滋病毒STI检测的障碍和促进者，以及如何 这些障碍和促进者可能因性别而异。为了解决这些差距，我们的团队将检查 性活跃的TNB人群是否具有基于性别的差异(反 女性/变性男性/非双性恋者)非艾滋病毒性传播感染检测率和障碍以及 非HIV性传播感染检测的促进者。我们将进行一种解释性的顺序混合方法 使用2018年密歇根州跨健康调查(MOHS)的二次定量数据进行的研究 以及对使用在线焦点小组的TNB人员的初步定性研究。首先，我们将确定 A)终身非HIV性传播感染检测率(从未、曾经)和b)基于性别的差异 最近一次非HIV性传播感染检测以来的时间(从未，过去一年，1-5年，&>5年) TNB人。然后，在借鉴社会生态的完整概念框架的指导下， 少数族裔压力和性别肯定，我们将审查个人(例如，种族/民族)， 医疗(例如，激素治疗)；社会(例如，基于性别认同的提供者歧视)； 结构性因素(例如，临床性别肯定)与终生非 HIV STI检测历史，以及性别认同是否会调节一生之间的联系 非HIV STI检测历史和统计学上显著相关的自变量。最后， 我们将收集和分析TNB人员的初步定性数据，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者。这项研究将为未来的研究提供信息，重点是 制定、评估和实施可增加非HIV STI检测的干预措施 在TNB人群中，填补研究中的关键空白，特别是针对被忽视的需求的研究 一群跨性别者和非双性恋者。

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.