Psychosocial and sexual factors associated with recent sexual health clinic attendance and HIV testing among trans people in the UK

Abstract

ObjectivesTrans people remain an understudied population in the UK, with unmet sexual health needs. The aim of this research was to identify possible barriers and facilitators for sexual health clinic attendance and HIV testing among trans people.MethodsLesbian, gay, bisexual and transgender (LGBT) participants from across the UK were invited to take part in a cross-sectional online survey through Facebook advertising (April–June 2018). Psychosocial and sexual factors associated with recent sexual health clinic attendance, and ever having an HIV test were examined using multivariate logistic regression.ResultsA total of 3007 cisgender and 500 trans participants completed the survey. Trans participants were less likely to attend a sexual health clinic than cisgender participants (27% vs 36%, p<0.001) and report ever having an HIV test (49% vs 64%, p<0.001). One trans participant reported living with HIV and three reported currently taking pre-exposure prophylaxis. Factors associated with trans sexual health clinic attendance were: living in London, having a relationship with multiple partners, engaging in condomless anal intercourse, greater life satisfaction, and having alcohol and/or drugs before sex. Being a person of colour, aged 25–49 years, in a relationship with multiple partners, condomless anal intercourse, lower body dissatisfaction, and having drugs before sex were associated with ever having an HIV test among trans participants.ConclusionsTrans people were less likely to attend sexual health services than cisgender people, and half of trans participants who reported condomless anal intercourse had never had an HIV test. Further research is needed to understand and improve uptake of sexual health services among trans people.

Impact and acceptability of HIV self-testing for trans men and trans women: A mixed-methods subgroup analysis of the SELPHI randomised controlled trial and process evaluation in England and Wales

“…The primacy of these issues suggest generic HIV testing services are neither accessible nor appropriately tailored for trans people in England and Wales, including those services that advertise as LGBT inclusive. These findings are consistent with research from the UK and other settings [ 5 , [7] , [8] , [9] , [10] ]. It should be noted that services designed specifically for trans people were very highly valued.…”

“…Trans women are also disproportionately represented in sex work, leading to additional sexual health needs which may be poorly met by existing services [11]. HIV testing rates among trans people in the UK are sub-optimal, with 49% of 500 trans participants reporting no lifetime HIV testing in a recent study [5].…”

“…Trans people and in particular trans women are a key population at increased risk of HIV acquisition, yet are severely underserved in the global response, including in HIV prevention and testing research [ 2 , 3 ]. There is also a lack of data on the sexual health needs of trans men and women in the UK, despite the fact that this group is more likely to be diagnosed with HIV late, less likely to attend sexual health clinics and less likely to test for HIV than cisgender men who have sex with men (MSM) [4] , [5] , [6] .…”

“…Trans people globally face barriers to HIV testing and prevention services not experienced by other groups [7] . These barriers include services which are not culturally appropriate, health care provider hostility and lack of understanding, the risk of arrest and imprisonment and barriers surrounding trans visibility and associated vulnerability [ 5 , 7 – 10 ]. Trans women are also disproportionately represented in sex work, leading to additional sexual health needs which may be poorly met by existing services [11] .…”

Improving the sexual health of young people (under 25) in high-risk populations: a systematic review and meta-analysis of behavioural and psychosocial interventions.

“…Whilst ve trials of YMSM were identi ed, none were found that focused on other LGBTQI + groups. There is a notable dearth of interventions for this group (excluding YMSM/MSM), particularly for trans youth (64).…”