Racial/Ethnic Differences in Sexually Transmitted Infection Testing Among Transgender Men and Nonbinary Assigned Female at Birth Young Adults in the United States: a National Study.

Abstract

Sexually transmitted infections (STIs) cause a major burden of disease in the United States (US)-especially among structurally marginalized populations, including transgender and nonbinary people, individuals assigned female at birth (AFAB), Black and Latinx/e individuals, and young adults. Although screening can help detect and prevent STIs, research on STI testing among populations at diverse intersections of multiple forms of structural marginalization, including Black, Latinx/e, and other racially/ethnically minoritized transgender men and nonbinary AFAB US young adults, is extremely scarce. We conducted a national cross-sectional online survey of transgender and nonbinary US young adults from February to July 2019. Using Poisson regression, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the associations between race/ethnicity-which we conceptualized as a system of structural inequality that shapes individuals' and groups' exposure to racism-and lifetime and past-year STI testing among transgender men and nonbinary AFAB US young adults aged 18-30years with at least one-lifetime sexual partner (N = 378). Approximately 74% of participants had received an STI test in their lifetime, and, among those, 72% with a past-year sexual partner had been tested for an STI in the last 12months. We observed no statistically significant association between race/ethnicity and lifetime STI testing among transgender and nonbinary AFAB young adults with a lifetime sexual partner. In contrast, Black (PR = 1.32; 95%: 1.03, 1.68) and Latinx/e (PR = 1.39; 95% CI: 1.11, 1.75) transgender men and nonbinary AFAB young adults who ever received an STI test and had a past-year sexual partner were significantly more likely to have received an STI test in the last 12months relative to their White counterparts, adjusting for demographic factors. Further adjustment for lifetime STI diagnosis and health insurance status did not appreciably attenuate these observed adjusted differences; however, the adjusted difference in the prevalence of past-year STI testing between Black (but not Latinx/e) and White transgender men and nonbinary AFAB young adults was no longer statistically significant upon further adjustment for educational attainment and employment status, possibly due to small sample sizes. The higher adjusted prevalence of past-year STI testing among Black and Latinx/e compared to White transgender men and nonbinary AFAB US young adults may reflect racist and xenophobic sexual stereotypes about Black and Latinx/e people among health care providers and institutions, the history of hyper-surveillance of Black and Latinx/e people by public health institutions in the context of infectious disease containment, and/or agency and resistance among Black and Latinx/e transgender men and nonbinary AFAB young adults with regard to sexual health promotion in the face of multiple compounding systems of oppression.