Inequities in access to HIV prevention services for transgender men: Results of a global survey of men who have sex with men

Ayden I. Scheim, Glenn Milo Santos, Sonya Arreola, Keletso Makofane, Tri D. Do, Pato Hebert, Matthew Thomann, George Ayala

Research output: Contribution to journalArticle

Abstract

Introduction: Free or low-cost HIV testing, condoms, and lubricants are foundational HIV prevention strategies, yet are often inaccessible for men who have sex with men (MSM). In the global context of stigma and poor healthcare access, transgender (trans) MSM may face additional barriers to HIV prevention services. Drawing on data from a global survey of MSM, we aimed to describe perceived access to prevention services among trans MSM, examine associations between stigma and access, and compare access between trans MSM and cisgender (non-Transgender) MSM. Methods: The 2014 Global Men's Health and Rights online survey was open to MSM (inclusive of trans MSM) from any country and available in seven languages. Baseline data (n-3857) were collected from July to October 2014. Among trans MSM, correlations were calculated between perceived service accessibility and anti-Transgender violence, healthcare provider stigma, and discrimination. Using a nested matched-pair study design, trans MSM were matched 4:1 to cisgender MSM on age group, region, and HIV status, and conditional logistic regression models compared perceived access to prevention services by transgender status. Results: About 3.4% of respondents were trans men, of whom 69 were included in the present analysis. The average trans MSM participant was 26 to 35 years old (56.5%); lived in western Europe, North America, or Oceania (75.4%); and reported being HIVnegative (98.6%). HIV testing, condoms, and lubricants were accessible for 43.5, 53.6, and 26.1% of trans MSM, respectively. Ever having been arrested or convicted due to being trans and higher exposure to healthcare provider stigma in the past six months were associated with less access to some prevention services. Compared to matched cisgender controls, trans MSM reported significantly lower odds of perceived access to HIV testing (OR-0.57, 95% CI-0.33, 0.98) and condom-compatible lubricants (OR-0.54, 95% CI-0.30, 0.98). Conclusions: This first look at access to HIV prevention services for trans MSM globally found that most reported inadequate access to basic prevention services and that they were less likely than cisgender MSM to have access to HIV testing and lubricants. Results indicate the need to enhance access to basic HIV prevention services for trans MSM, including MSM-specific services.

Original languageEnglish (US)
Article numberA9
JournalJournal of the International AIDS Society
Volume19
DOIs
StatePublished - Jul 17 2016

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Transgender Persons
HIV
Lubricants
Condoms
Surveys and Questionnaires
Health Personnel
Logistic Models
Oceania
Men's Health

Keywords

  • Health services
  • HIV prevention
  • HIV testing
  • Men who have sex with men
  • Transgender

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Inequities in access to HIV prevention services for transgender men : Results of a global survey of men who have sex with men. / Scheim, Ayden I.; Santos, Glenn Milo; Arreola, Sonya; Makofane, Keletso; Do, Tri D.; Hebert, Pato; Thomann, Matthew; Ayala, George.

In: Journal of the International AIDS Society, Vol. 19, A9, 17.07.2016.

Research output: Contribution to journalArticle

Scheim, Ayden I. ; Santos, Glenn Milo ; Arreola, Sonya ; Makofane, Keletso ; Do, Tri D. ; Hebert, Pato ; Thomann, Matthew ; Ayala, George. / Inequities in access to HIV prevention services for transgender men : Results of a global survey of men who have sex with men. In: Journal of the International AIDS Society. 2016 ; Vol. 19.
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abstract = "Introduction: Free or low-cost HIV testing, condoms, and lubricants are foundational HIV prevention strategies, yet are often inaccessible for men who have sex with men (MSM). In the global context of stigma and poor healthcare access, transgender (trans) MSM may face additional barriers to HIV prevention services. Drawing on data from a global survey of MSM, we aimed to describe perceived access to prevention services among trans MSM, examine associations between stigma and access, and compare access between trans MSM and cisgender (non-Transgender) MSM. Methods: The 2014 Global Men's Health and Rights online survey was open to MSM (inclusive of trans MSM) from any country and available in seven languages. Baseline data (n-3857) were collected from July to October 2014. Among trans MSM, correlations were calculated between perceived service accessibility and anti-Transgender violence, healthcare provider stigma, and discrimination. Using a nested matched-pair study design, trans MSM were matched 4:1 to cisgender MSM on age group, region, and HIV status, and conditional logistic regression models compared perceived access to prevention services by transgender status. Results: About 3.4{\%} of respondents were trans men, of whom 69 were included in the present analysis. The average trans MSM participant was 26 to 35 years old (56.5{\%}); lived in western Europe, North America, or Oceania (75.4{\%}); and reported being HIVnegative (98.6{\%}). HIV testing, condoms, and lubricants were accessible for 43.5, 53.6, and 26.1{\%} of trans MSM, respectively. Ever having been arrested or convicted due to being trans and higher exposure to healthcare provider stigma in the past six months were associated with less access to some prevention services. Compared to matched cisgender controls, trans MSM reported significantly lower odds of perceived access to HIV testing (OR-0.57, 95{\%} CI-0.33, 0.98) and condom-compatible lubricants (OR-0.54, 95{\%} CI-0.30, 0.98). Conclusions: This first look at access to HIV prevention services for trans MSM globally found that most reported inadequate access to basic prevention services and that they were less likely than cisgender MSM to have access to HIV testing and lubricants. Results indicate the need to enhance access to basic HIV prevention services for trans MSM, including MSM-specific services.",
keywords = "Health services, HIV prevention, HIV testing, Men who have sex with men, Transgender",
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T1 - Inequities in access to HIV prevention services for transgender men

T2 - Results of a global survey of men who have sex with men

AU - Scheim, Ayden I.

AU - Santos, Glenn Milo

AU - Arreola, Sonya

AU - Makofane, Keletso

AU - Do, Tri D.

AU - Hebert, Pato

AU - Thomann, Matthew

AU - Ayala, George

PY - 2016/7/17

Y1 - 2016/7/17

N2 - Introduction: Free or low-cost HIV testing, condoms, and lubricants are foundational HIV prevention strategies, yet are often inaccessible for men who have sex with men (MSM). In the global context of stigma and poor healthcare access, transgender (trans) MSM may face additional barriers to HIV prevention services. Drawing on data from a global survey of MSM, we aimed to describe perceived access to prevention services among trans MSM, examine associations between stigma and access, and compare access between trans MSM and cisgender (non-Transgender) MSM. Methods: The 2014 Global Men's Health and Rights online survey was open to MSM (inclusive of trans MSM) from any country and available in seven languages. Baseline data (n-3857) were collected from July to October 2014. Among trans MSM, correlations were calculated between perceived service accessibility and anti-Transgender violence, healthcare provider stigma, and discrimination. Using a nested matched-pair study design, trans MSM were matched 4:1 to cisgender MSM on age group, region, and HIV status, and conditional logistic regression models compared perceived access to prevention services by transgender status. Results: About 3.4% of respondents were trans men, of whom 69 were included in the present analysis. The average trans MSM participant was 26 to 35 years old (56.5%); lived in western Europe, North America, or Oceania (75.4%); and reported being HIVnegative (98.6%). HIV testing, condoms, and lubricants were accessible for 43.5, 53.6, and 26.1% of trans MSM, respectively. Ever having been arrested or convicted due to being trans and higher exposure to healthcare provider stigma in the past six months were associated with less access to some prevention services. Compared to matched cisgender controls, trans MSM reported significantly lower odds of perceived access to HIV testing (OR-0.57, 95% CI-0.33, 0.98) and condom-compatible lubricants (OR-0.54, 95% CI-0.30, 0.98). Conclusions: This first look at access to HIV prevention services for trans MSM globally found that most reported inadequate access to basic prevention services and that they were less likely than cisgender MSM to have access to HIV testing and lubricants. Results indicate the need to enhance access to basic HIV prevention services for trans MSM, including MSM-specific services.

AB - Introduction: Free or low-cost HIV testing, condoms, and lubricants are foundational HIV prevention strategies, yet are often inaccessible for men who have sex with men (MSM). In the global context of stigma and poor healthcare access, transgender (trans) MSM may face additional barriers to HIV prevention services. Drawing on data from a global survey of MSM, we aimed to describe perceived access to prevention services among trans MSM, examine associations between stigma and access, and compare access between trans MSM and cisgender (non-Transgender) MSM. Methods: The 2014 Global Men's Health and Rights online survey was open to MSM (inclusive of trans MSM) from any country and available in seven languages. Baseline data (n-3857) were collected from July to October 2014. Among trans MSM, correlations were calculated between perceived service accessibility and anti-Transgender violence, healthcare provider stigma, and discrimination. Using a nested matched-pair study design, trans MSM were matched 4:1 to cisgender MSM on age group, region, and HIV status, and conditional logistic regression models compared perceived access to prevention services by transgender status. Results: About 3.4% of respondents were trans men, of whom 69 were included in the present analysis. The average trans MSM participant was 26 to 35 years old (56.5%); lived in western Europe, North America, or Oceania (75.4%); and reported being HIVnegative (98.6%). HIV testing, condoms, and lubricants were accessible for 43.5, 53.6, and 26.1% of trans MSM, respectively. Ever having been arrested or convicted due to being trans and higher exposure to healthcare provider stigma in the past six months were associated with less access to some prevention services. Compared to matched cisgender controls, trans MSM reported significantly lower odds of perceived access to HIV testing (OR-0.57, 95% CI-0.33, 0.98) and condom-compatible lubricants (OR-0.54, 95% CI-0.30, 0.98). Conclusions: This first look at access to HIV prevention services for trans MSM globally found that most reported inadequate access to basic prevention services and that they were less likely than cisgender MSM to have access to HIV testing and lubricants. Results indicate the need to enhance access to basic HIV prevention services for trans MSM, including MSM-specific services.

KW - Health services

KW - HIV prevention

KW - HIV testing

KW - Men who have sex with men

KW - Transgender

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