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Sexual Behaviors Associated with HIV Transmission Among Transgender and Gender Diverse Young Adults: The Intersectional Role of Racism and Transphobia

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Abstract

HIV prevalence and engagement in sexual behaviors associated with HIV transmission are high among transgender people of color. Per intersectionality, this disproportionate burden may be related to both interpersonal and structural racism and transphobia. The goal of this study was to estimate the association between interpersonal and structural discrimination and sexual behaviors among transgender and gender diverse (TGD) U.S. young adults. We used logit models with robust standard errors to estimate the individual and combined association between interpersonal and structural racism and transphobia and sexual behaviors in a national online sample of TGD young adults of color (TYAOC) aged 18–30 years (N = 228). Racism was measured at the interpersonal and structural level using the Everyday Discrimination Scale and State Racism Index, respectively. Transphobia was measured at the interpersonal and structural level using the Gender Minority Stress Scale and the Gender Identity Tally, respectively. We found that interpersonal racism was associated with transactional sex, and interpersonal transphobia was associated with alcohol/drug consumption prior to sex and transactional sex among TYAOC. We also found evidence of a strong joint association of interpersonal and structural racism and transphobia with alcohol/drug consumption prior to sex (OR 3.85, 95% CI 2.12, 7.01) and transactional sex (OR 3.54, 95% CI 0.99, 12.59) among TYAOC. Racism and transphobia have a compounding impact on sexual behaviors among TYAOC. Targeted interventions that reduce discrimination at both the interpersonal and structural level may help reduce the HIV burden in this marginalized population.

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Data Availability

The data used in this study is part of ongoing work and can be requested through a data use agreement.

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R code for analyses are available upon request.

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Acknowledgements

Elle Lett would like to thank the CHOP Leadership Education in Adolescent Health Fellowship for their support. ENA would like to thank the Robert Wood Johnson Foundation Health Policy Scholars for their support. EL and ENA would also like to thank the Black Health Scholars Network and the E2 Social Epi Lab for for their support of this work

Funding

ND was supported by the Stoneleigh Foundation. JA was supported in part by an American Cancer Society—Tri-State CEO’s Against Cancer Mentored Research Scholar Grant, MRSG-17–155-01-CPPB. The B*SHARP study was supported by the Aerosmith Endowment Fund for the Prevention and Treatment of HIV and Other STIs at Boston Children’s Hospital (PI: Gordon), the Harvard University Open Gate Foundation (PI: Murchison), and a Research Education Institute for Diverse Scholars (REIDS) pilot grant (PI: Agénor) from National Institute of Mental Health grant 1R25GM111837-01 awarded to the Center for Interdisciplinary Research on AIDS at Yale University. All authors would like to thank the transgender and gender diverse young adults who participated in the B*SHARP study.

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Authors and Affiliations

  1. Center for Applied Transgender Studies, Chicago, IL, USA

    Elle Lett

  2. Perelman School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, PA, 19146, USA

    Elle Lett

  3. Yale School of Public Health, New Haven, CT, USA

    Emmanuella Ngozi Asabor

  4. Yale School of Medicine, New Haven, CT, USA

    Emmanuella Ngozi Asabor

  5. Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA

    Nguyen Tran

  6. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Nadia Dowshen

  7. Craig-Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Nadia Dowshen

  8. Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Jaya Aysola

  9. Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Jaya Aysola

  10. Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA

    Allegra R. Gordon

  11. Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA

    Allegra R. Gordon

  12. Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA

    Madina Agénor

  13. The Fenway Institute, Fenway Health, Boston, MA, USA

    Madina Agénor

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  1. Elle Lett
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  2. Emmanuella Ngozi Asabor
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  4. Nadia Dowshen
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Contributions

EL conceptualized the study and performed the analysis and wrote the initial draft. MA aided in conceptualization. All other authors critically revised the submission for publication and aided in results interpretation.

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Correspondence to Elle Lett.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of Boston Children’s Hospital Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Lett, E., Asabor, E.N., Tran, N. et al. Sexual Behaviors Associated with HIV Transmission Among Transgender and Gender Diverse Young Adults: The Intersectional Role of Racism and Transphobia. AIDS Behav 26, 3713–3725 (2022). https://doi.org/10.1007/s10461-022-03701-w

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