Despite having less access to gender-affirming care, Black and Latino trans teens and young adults were much more likely to have ever received an HIV test and more likely to have heard of pre-exposure prophylaxis (PrEP) than white youth, according to a national survey published in LGBT Health.

The study didn’t ascertain actual PrEP use, though previous data suggest that Black trans adults are less likely than their white counterparts to receive HIV prevention partner services, including PrEP. Still, the report adds to accumulating data showing that people with access to gender-affirming care have better health outcomes, including HIV outcomes.

PhD candidate Jack Andrzejewski, MPH, of Oak Ridge Associated Universities and San Diego State University, and colleagues gathered survey results from 1,029 transgender young people between January and April 2018. The survey asked them about their sexual experience, experience with gender-affirming services, awareness and use of PrEP, HIV and sexually transmitted infection (STI) testing and awareness of post-exposure prophylaxis (PEP).

Participants were at least 13 years old and a maximum of 24 years old; the median age was 19. Nearly half were trans girls or young women, 29% were trans boys or young men and 26% were nonbinary; 53% were youth of color.

In total, one in five (19%) had accessed any gender-affirming services, which in this case included the use of gender-affirming hormones or hormones that delayed puberty. But the likelihood of having gender-affirming hormonal care varied widely. For instance, even though young transgender women accounted for 46% of the total cohort, just 15% of them had ever accessed gender-affirming care. Meanwhile, one in three transgender boys and young men had ever accessed gender-affirming care, but only one in 10 nonbinary young people had done so.

Persistent racial gaps in care were present as well. One in five white trans young people had accessed gender-affirming care, compared with just 7% of Black trans people. And 18% of Latino trans individuals had accessed gender-affirming services. While 73% of the youth overall reported having health insurance, 76% of those who accessed gender-affirming care said they did so without insurance.

Participants who had access to gender-affirming care appeared to have better access to adolescent health care in general, including STI testing and information about PrEP and PEP. Young people who received appropriate health care were also 90% more likely to have ever had an STI test and 85% more likely to have heard of PrEP. But while access to gender-affirming care made it nearly three times as likely that nonbinary and trans-masculine young people would know about PrEP and PEP, there was no such association for young trans women. There appeared to be no association between access to appropriate gender care and PrEP awareness for those young women.

However, there was a racial difference here as well, and it was the opposite of the disparity above. White trans teens were far less likely than either their Black or Latino counterparts to have ever been tested for HIV or STIs. Indeed, although they were less likely to have received gender-affirming care, young Black people were 74% more likely than their white counterparts to have ever been tested for HIV and 83% more likely to have ever had an STI test. Latinos were also 61% more likely to have been tested for HIV and 66% more likely to have heard of PrEP.

Click here to read the text of the study.

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