Ashley Lacombe-Duncan

Introduction: Transgender (trans) and gender diverse (TGD) people are disproportionately affected by sexually transmitted infections (STIs), including those other than Human Immunodeficiency Virus (HIV), driven in part by anti-trans stigma and intersecting systems of oppression that disrupt access to sexual healthcare. This study aimed to highlight the intersectional barriers TGD adults encounter when accessing sexual healthcare. Methods: In 2022, 10 semi-structured focus groups were conducted with a sample of thirty-six TGD adults, including nonbinary individuals ( n = 26, 72.0%), trans men ( n = 7, 19.4%), and trans women ( n = 3, 8.3%). Just over one-quarter of participants ( n = 10, 28.0%) identified as people of color. Data were analyzed using reflexive thematic analysis to generate themes related to intersectional stigma and TGD adults’ sexual healthcare experiences. Results: Two themes were created from the data: (1) Beyond anti-trans stigma: The overlooked systems that adversely shape STI testing and care among TGD people; and (2) “I have to test the waters on all of those things”: How interlocking oppression compounds barriers to care. Structural stigmas manifested at multiple levels, underscoring how intersecting oppression created and reinforced barriers to sexual healthcare access. Conclusions: The study highlights how intersecting systems of oppression shape barriers to affirming sexual healthcare among TGD adults. Findings signaled the importance of training healthcare providers and changing institutional policies and practices to foster affirming healthcare environments and address barriers to STI prevention, testing, and care, thereby promoting sexual health equity. Policy Implications: Findings support the need for intersectional, structural-level change, including state- or municipal-level legal protections and accessible insurance coverage policies. At the institutional level, revising health informatics, provider training curricula, and intake forms can help create trans-inclusive spaces and further ensure access to affirming testing and sexual healthcare experiences.

Transgender (trans) and gender diverse (TGD) people experience sexual health inequities, including high rates of HIV and other sexually transmitted infecti

Gender affirming health care (GAHC), particularly gender-affirming hormone therapy, can promote the well-being of transgender women/transfeminine persons. Social gender affirmation, in the form of social support (e.g., use of one's authentic name and pronouns), may complement and strengthen trans people's experiences with GAHC. Most research to-date has focused on social support during GAHC with children and adolescents rather than adults, who experience unique social support needs when navigating health care. Given this gap and an increasingly hostile sociopolitical context limiting transgender and gender diverse people's access to both GAHC and social support, we explored the social support experiences of trans women/transfeminine persons taking gender-affirming hormone therapy. We utilized a convergent parallel mixed methods study design drawing on secondary cross-sectional survey data from 214 trans women/transfeminine persons in Canada aged 18+ taking gender-affirming hormone therapy for ≥3 months. Bivariable analyses explored factors associated with having social support while accessing GAHC. Qualitative data from open-ended survey responses were analyzed using directed qualitative content analysis. Among participants (mean age: 32.3, standard deviation: 10.8), most (94.4%) reported having at least one person who supported them. Those receiving social assistance and those of Black race/ethnicity were statistically significantly less likely to report having social support. Narratives revealed positive and negative interpersonal interactions from partners, family (parents, siblings, chosen), and friends (particularly queer-/trans-identified), influenced by emotional capacity, anti-trans stigma, and pretransition relationship dynamics. Social support improved individuals' mental health, increased participants' community connectedness, and enhanced trans joy. These findings underscore the importance of providers fostering social support among trans women/transfeminine people accessing GAHC. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Trans and gender diverse (TGD) people have heightened vulnerability to HIV/sexually transmitted and blood-borne infections (STBBIs) driven, in part, by anti-trans stigma, yet they also face barriers to HIV/STBBI prevention and care. Integrating gender-affirming health care (GAHC; e.g., gender-affirming hormone therapy) with HIV/STBBI prevention/care could improve uptake of HIV/STBBI prevention/care for this population. Yet, the extent to which this integrated care is available is unknown. We conducted an environmental scan of active HIV/STBBI clinic websites in Ontario, Canada during June–September 2024, to determine the availability of HIV/STBBI services by geographic region and indicators of TGD inclusion. Of 198 clinic websites, 55.1% had visual or textual representation of TGD inclusion/support, with 21.7% stating nonmedical TGD affirmation programming (e.g., support group[s]) and 10.6% endorsing integrated HIV/STBBI prevention/care and GAHC. Findings underscore opportunities to increase integrated HIV/STBBI prevention and care and GAHC and to incorporate TGD inclusivity on websites to enhance TGD sexual health equity.

Background: Transgender (trans) women living with HIV often face barriers to accessing inclusive and comprehensive primary and HIV care. Objectives: We aimed to (1) describe differences in trans women’s disclosure of their trans identity and comfort discussing trans identity and trans-specific healthcare needs, based on physician type, and (2) report on the prevalence of negative trans-specific experiences with HIV physicians and any provider-related factors associated with comfort. Design: Data of trans participants in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) were analyzed across three waves (2013–2018). Methods: Descriptive statistics explored disclosure of trans identity and comfort discussing trans-specific healthcare needs with family physicians versus HIV physicians. Fisher’s exact tests of association explored the relationship between provider-related factors and self-reported comfort. Prevalence of negative trans-specific experiences with HIV physicians was reported. Results: At baseline, of 54 trans women, 39 (72.2%) had a physician who supervised their HIV care in the year preceding (HIV physician). Among this subset, 94.9% had disclosed their trans identity and 82.1% reported feeling comfortable discussing trans-specific healthcare needs with this physician. Of the 27 (50.0%) who reported having a regular family physician other than their HIV care provider, 92.6% had disclosed their trans identity and 88.9% were comfortable discussing trans-specific healthcare needs. The most prevalent negative trans-specific experience with HIV physicians reported cumulatively was being told by the physician that they did not know enough about trans-related care to provide care (16.7%). Conclusion: Our findings demonstrate a high prevalence of disclosure of trans identity to physicians among our trans participants. Our findings suggest trans women have similar comfort discussing trans-specific healthcare needs with their family and HIV physicians; however, negative experiences with HIV providers indicate the need for gender-affirming, trans-specific provider training.

Transgender and gender diverse (TGD) persons are disproportionately affected by sexually transmitted infection (STI) inequities. Research predominantly focuses on HIV disparities among transfeminine persons, whereas non-HIV STIs (e.g., chlamydia) and transmasculine and nonbinary persons are overlooked. Thus, we examined barriers and facilitators to uptake of non-HIV STI testing among TGD persons, inclusive of transmasculine, transfeminine, and nonbinary persons. This community-based explanatory sequential mixed-methods study utilized secondary quantitative data collected 2018–2019 from the Michigan Trans Health Survey (n = 528) analyzed utilizing logistic regression to test associations between social ecological hypothesized factors and non-HIV STI testing. Primary qualitative focus group data collected 2022 (n = 36 TGD participants) were analyzed using a reflexive thematic approach. In multivariable analyses adjusting for age and race, reporting a very/somewhat inclusive primary care provider and ever experiencing sexual violence were statistically significantly positively associated with testing. Five themes were identified that illustrated the complexity of the testing process: 1) The “why” motivating testing; 2) “I’ve been vocal”: The impact of individual agency on TGD peoples’ testing practices; 3) “It’s a big ordeal”: Running the gauntlet of testing; 4) “Doesn’t give me a hassle”: Gratitude for bare minimum dignity when accessing care; and, 5) “Open, honest, and transparent”: Increased testing access due to collaborative, judgment-free, and trustworthy patient-provider relationships. Findings inform future interventions to increase STI testing among TGD populations, such as enhanced trauma-informed, intersectional, and gender-affirming STI testing, across urgent care, sexual and reproductive healthcare, and primary care. Findings call for systems-level change to promote such care to increase STI testing and advance health equity among TGD populations.

Although literature regarding HIV prevention among transgender and nonbinary (TNB) people has grown considerably, important gaps remain, particularly in relation to the HIV pre-exposure prophylaxis (PrEP) care cascade. Additional research is needed to understand when and why TNB people exit the PrEP care cascade to inform interventions to better support these populations. Moreover, most studies have focused on transgender women, though transgender men and nonbinary people also experience a disproportionate prevalence of HIV relative to cisgender populations. This study addresses these gaps by exploring engagement in the PrEP care cascade among a statewide convenience sample of 659 transgender women, transgender men, and nonbinary people, and analyzing how gender identity impacts participant likelihood to continue along the cascade. Data come from the 2018 Michigan Trans Health Study and include self-report data on demographics, sexual behavior, and PrEP awareness, information receipt, referral, initiation, and retention. Participants who self-reported vaginal/front hole or anal sex and did not use barriers (n = 318) were considered eligible for PrEP. Only 21.13% of those eligible for PrEP received information about PrEP, 8.18% were referred to PrEP, and 1.57% initiated PrEP use. A significantly greater proportion of transfeminine and participants who identified with multiple/other genders reported receiving PrEP information than those who identified as transmasculine or nonbinary [χ² (3, n = 311) =11.34, p = .01]. No other significant gender differences were observed. Providers serving TNB individuals must recognize the diversity of individuals who qualify for information on PrEP, provide trans-affirming care when offering PrEP prescriptions, and consider situating PrEP opportunities in TNB serving spaces to reduce access barriers.

Background: Access to timely, gender affirming healthcare (GAH) for transgender and gender diverse (TGD) people is lifesaving. Yet, little is known about the GAH experiences of TGD people during the height of the COVID-19 pandemic. Methods: Utilizing an explanatory sequential mixed methods design, and applying critical transgender and intersectional theories, we examined baseline survey data (n = 44) and follow-up semi-structured interview data (n = 18 qualitative sub-sample from quantitative participants) with a cohort of TGD persons from a COVID-19 eHealth intervention (#SafeHandsSafeHearts) in Toronto, Canada. Results: One-sixth (n = 6/39, 15.4%) of the survey sample reported reduced access to GAH because of COVID-19. Qualitative participants described widespread barriers to access and negative mental health impacts given de-prioritization of TGD health during the pandemic. The cessation of gender affirming surgeries, deemed nonessential, was of greatest concern, along with fear that substantial progress made in improving access to GAH was being unraveled. Nevertheless, community resilience was highlighted through discussion of community support, particularly the development of TGD communities of care to compensate for the lack of institutional support. Despite these struggles, participants embodied trans joy, an act of resistance, refusing to be erased by a system that devalues their healthcare needs. Conclusions: Results inform recommendations for TGD healthcare and improvements that reprioritize TGD community health.