Associations Between Social Support Availability and HIV Risk and Protective Factors in a U.S. Sample of Adults with Diverse Transgender Identities

HIV Testing and PrEP Use Among Trans and/or Non-binary Participants in the TASG Study, a Participatory Study in Germany

HIV testing and pre-exposure prophylaxis (PrEP) are recommended in Germany for individuals at increased HIV risk. However, data on HIV testing, PrEP use, and PrEP knowledge among trans and non-binary people are limited. We analysed data from the 'Sexuelle Gesundheit in trans und nicht-binären Communitys' (TASG) study, a participatory study on HIV/STI and sexual health among trans and non-binary people in Germany. The study was designed, promoted, and analysed with active involvement of community members. Participants were invited to complete an anonymous online survey between 1 March and 1 July 2022. The outcomes included HIV testing within the last 5 years, PrEP use, and PrEP-specific knowledge. Predictors for HIV testing were identified using a bootstrap stepwise selection procedure. Among 2468 HIV-negative participants with information on potential HIV risks, 21.5% had potential needs for HIV testing and PrEP. Of these, only 44.3% (208/470, missing: 60) reported testing for HIV within the last 5 years. Older participants, those living in larger cities, and those with higher education levels were more likely to have tested for HIV. Additionally, only 8.3% (38/459, missing: 71) reported ever using PrEP. Among 451 participants with potential PrEP needs (missing: 79), only 57.4% knew at least one of three key PrEP-related facts at the time of the survey. Our findings highlight substantial gaps in HIV testing and prevention among trans and non-binary individuals in Germany with potential needs for these services. Reducing barriers to testing and prevention is essential to enable broader access to these critical services.

Pre-exposure Prophylaxis: Clinical Considerations for Overcoming Barriers to Uptake and Persistence

ABSTRACT

Pre-exposure prophylaxis (PrEP) is the administration of antiretroviral medications before HIV exposure to prevent HIV infection. PrEP or biomedical prevention is an essential part of the ending the HIV epidemic strategy. Currently, there are 4 guideline-approved dosing approaches to PrEP, which include 2 oral formulations and 1 long-acting injectable. Unfortunately, most individuals who would benefit from PrEP do not receive a prescription, and even fewer initiate and continue PrEP. Barriers to PrEP uptake and persistence are complex and extend along a socio-ecologic framework from individual through structural. In this article, we highlight the barriers to PrEP care among priority populations, discuss evidence-based solutions, and offer multilevel considerations for clinicians, researchers, and community members to increase access, uptake, and persistence in PrEP care for all.

Global Human Immunodeficiency Virus Prevalence and Risk Behaviors in Transmasculine Individuals: A Scoping Review

Purpose

This scoping review sought to synthesize human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevalence, incidence, risk behaviors, and risk perceptions among transmasculine (TM) individuals globally.

Methods

Eligible articles were peer-reviewed observational and interventional studies published in English between August 2, 2014 and November 2, 2021. Four electronic databases were systematically searched: PubMed, Embase, PsycInfo, and Sociological Abstracts and reference lists hand-searched. Results are presented using numerical summary and thematic analysis.

Results

Studies meeting inclusion criteria (n=39) spanned 12 countries and 2 multi-region studies. Laboratory-confirmed HIV prevalence ranged from 0% to 4% and self-reported HIV prevalence from 0% to 8%. Laboratory-confirmed STI diagnoses ranged from 1.2% to 7.7% for chlamydia, 0% to 10.5% for gonorrhea, 0% to 6% for syphilis, 1% to 8% for hepatitis C, and 0% to 8% for hepatitis B. Self-reported lifetime diagnosis of any STI ranged from 5.8% to 53.7%. No studies assessed HIV or STI incidence. Lifetime HIV testing prevalence varied from 23% to 89%. Lifetime STI testing prevalence ranged from 31.1% to 70.8%. Pre- and post-exposure prophylaxis use and knowledge were assessed in seven studies. Qualitative studies addressed HIV vulnerabilities and protective factors, including stigma and social, medical, and legal supports.

Conclusion

Although TM individuals are vulnerable to HIV and STI, incidence data are lacking. There is a dearth of research on the experiences, risk factors, and sexual behaviors of TM individuals, especially those who are nonbinary or ethnoracially minoritized. The collection of gender identity data in routine HIV surveillance is recommended. Services and interventions developed by and for TM individuals are needed.

Characterisation of social support following incarceration among black sexual minority men and transgender women in the HPTN 061 cohort study

OBJECTIVE

To examine longitudinal associations between recent incarceration and subsequent social support among black sexual minority men and transgender women, and whether associations differed between those who did and did not have support prior to incarceration.

DESIGN

A secondary analysis in 2020 of data from the HIV Prevention Trials Network 061, a cohort study of black sexual minority men and transgender women recruited in 2009-2010 and followed for 12 months.

SETTING

Six US cities (Atlanta, Boston, Los Angeles, New York City, San Francisco and Washington DC).

PARTICIPANTS

Individuals ≥18 years of age who identified as black, reported being male or assigned male at birth, reported ≥1 unprotected anal intercourse event with a male partner in the past 6 months, and reported on incarceration at the 6-month follow-up visit.

EXPOSURE

Having spent ≥1 night in jail/prison in the past 6 months reported at the 6-month follow-up visit.

OUTCOME

Social support measured using a six-item scale assessing frequency of emotional/informational, affectionate and tangible support (range 6-30); and dichotomous indicators of low support for each item (ie, receiving that form of support none/little of the time).

RESULTS

Among participants who returned for the 6-month visit (N=1169), 14% had experienced incarceration in the past 6 months. Mean support score was 20.9; 18.9 among those with recent incarceration versus 21.2 among those without. Recent incarceration predicted lower support (adjusted β -2.40, 95% CI -3.94 to -0.85). Those recently incarcerated had increased risk of lacking emotional/informational (eg, no one to talk to adjusted risk ratio (aRR) 1.55, 95% CI 1.13 to 2.13) and affectionate (aRR 1.51, 95% CI 1.11 to 2.04) but not tangible support. Effects appeared somewhat stronger among those who had support at baseline.

CONCLUSIONS

Incarceration may reduce support on re-entry among black sexual minority men and transgender women, populations unequally targeted for incarceration and at risk for low support.