Health and service utilization among a sample of gender-diverse youth of color: the TRUTH study

Abstract

Background While there is growing research considering the experiences of transgender youth whose identities align with the gender binary, especially among young trans women, there are significantly fewer studies that accurately capture data about nonbinary youth, and even fewer studies capturing the experiences of transgender and gender diverse (TGD) youth of color. The purpose of this research was to assess the prevalence of sexual health behaviors, mental health challenges, substance use, and healthcare utilization among Black/African American, Latinx, Asian/Pacific Islander, indigenous and multi-racial/ethnic TGD youth, who have been largely underrepresented in research. Methods A total of 108 TGD youth ages 16–24 were recruited into the Trans Youth of Color Study (TRUTH). Each participant completed a 90-min survey administered by a research assistant with more sensitive information collected using ACASI. In addition to a completing a survey administered by research staff, participants also participated in specimen collection, which included urine sampling to assess recent substance use without a prescription, self-collected rectal/frontal and throat swabs to test for gonorrhea and chlamydia, and a blood draw to test for recent use of drugs, gonorrhea and chlamydia, and syphilis. The sample was recruited at public venues, community outreach and referral, through social media outreach, and via participant referral. Cross-sectional analyses were from a single study visit. Results Compared to rates among their cisgender peers, participants reported experiencing adverse social and structural determinants of health—e.g. food insecurity (61%), housing instability (30%), and limited access to healthcare (26% had no place to go for healthcare)—and elevated rates of illicit drug use (19–85%), mental health problems (e.g. 60% self-reported depression), and involvement in sexual risk-related behaviors (e.g. among those reporting penetrative sex 57–67% reported sex without a condom). Conclusions This study adds descriptions of both mental and sexual health outcomes of a non-clinical sample of TGD youth to the literature, particularly among young transgender men and gender nonbinary youth, who have frequently been excluded from previous studies of sexual health. The findings document experiences and behaviors among TGD youth that contribute to mental and sexual health concerns, including rates of substance use, and healthcare utilization.

Binary and Non-binary Gender Identities, Internalizing Problems, and Treatment Wishes Among Adolescents Referred to a Gender Identity Clinic in Germany

“…In contrast, other clinical and non-clinical studies found no evidence for elevated rates of internalizing conditions in non-binary youth compared to binary youth (e.g., Aparicio-García et al, 2018 ; Fontanari et al, 2020 ; Rusow et al, 2022 ; Tordoff et al, 2022 ; Table S1). Furthermore, some studies highlight that there may be differences between AFAB and AMAB non-binary adolescents, highlighting the need to take the birth-assigned sex into account (McKay & Watson, 2020 ; Parodi et al, 2022 ; Rimes et al, 2019 ; Thoma et al, 2019 ).…”

Evaluating the Feasibility and Acceptability of a Digital Pre-Exposure Prophylaxis Navigation and Activation Intervention for Racially and Ethnically Diverse Sexual and Gender Minority Youth (PrEPresent): Protocol for a Pilot Randomized Controlled Trial

“…Within the Transgender Youth of Color Cohort Study, 67% of nonbinary youth assigned female at birth and 65% of transgender men reported condomless sexual interactions in the last 6 months. Despite these rates of condomless sex within the cohort, only 8% had taken PrEP in their lifetime and 3% of participants reported actively taking PrEP [ 17 ]. This underscores the urgent need for interventions that specifically focus on PrEP uptake within SGMY populations.…”