HIV Testing Frequency & Predictors in a Statewide Sample of Transgender, Nonbinary, and Intersex Adults

Background: Transgender, nonbinary, and intersex (TNBI) adults are disproportionately affected by HIV compared to their cisgender counterparts, and few states and urban centers specifically report HIV testing rates among TNBI individuals. Recent scholarship suggests that HIV testing rates among trans and nonbinary (TNB) adults are below CDC recommendations. Moreover, the historical pattern of discriminatory practices and medical providers’ lack of competence in servicing TNBI individuals act as significant barriers to accessing vital HIV preventative care among this population. This study seeks to identify testing rates and correlates among TNBI adults in Colorado to inform crucial prevention and intervention strategies to improve HIV-related outcomes.

Methods: Data come from the Colorado Transgender and Nonbinary Health Survey (N=448), a community-engaged research collaboration between the University of Denver and One Colorado. Data were collected in 2021-2022 using a computerized self-report survey. Dependent variables were HIV testing ever and in the last year (0=no, 1=yes). Independent variables included gender (transfeminine, transmasculine, nonbinary, intersex), HIV risk (summative score of four binary variables including unprotected sex, sex with multiple partners, STI diagnosis in the last year, and sex while using drugs or alcohol), knowledge of TNBI health, history of being refused gender-affirming care and of needing to educate one’s provider about TNBI health, having a medical provider who does not make assumptions about sexual behaviors, and experiencing gender euphoria during sex. We used frequencies and cross tabs to calculate HIV testing rates by gender and multivariable logistic regression models predicting likelihood of HIV testing ever and in the last year using all independent variables.

Results: Approximately 29% of participants identified as transfeminine, 20% as transmasculine, 40% as nonbinary, and 11% as intersex. Participants were an average age of 29.59 years (SD=7.57). Roughly 52% of participants reported ever being tested for HIV, 67% of whom reported being tested in the last year. Those who identified as intersex reported a considerably lower frequency of ever being tested for HIV (29%) than other genders, while nonbinary participants reported the lowest frequency of HIV testing in the last year (56%). A multivariable logistic regression of ever being tested for HIV indicated that those who had to educate their medical providers about TNB health were significantly less likely to ever test for HIV (OR=0.63, 95% CI [0.43-0.91]). No other predictors of HIV testing ever or in the last year were statistically significant in multivariable models.

Conclusions & Implications: To the best of our knowledge, this is the first study that empirically identifies HIV testing rates among TNBI in the state of Colorado. The identified HIV testing rates among TNBI in this study are below the national average, indicating the need for more targeted and robust HIV prevention and intervention efforts in Colorado. Furthermore, this study critically identifies a significant gap in knowledge pertaining to HIV testing rates among intersex adults. Finally, these results indicate that medical providers must become educated and competent in treating TNBI persons who avail themselves of HIV testing services.