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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.
Vol.:(0123456789)
1 3
AIDS and Behavior
https://doi.org/10.1007/s10461-022-03701-w
ORIGINAL PAPER
Sexual Behaviors Associated withHIV Transmission Among
Transgender andGender Diverse Young Adults: The Intersectional Role
ofRacism andTransphobia
ElleLett1,2 · EmmanuellaNgoziAsabor3,4· NguyenTran5· NadiaDowshen6,7· JayaAysola8,9·
AllegraR.Gordon10,11· MadinaAgénor12,13
Accepted: 28 April 2022
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022
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.
Keywords Transgender· Race and structural racism· Transphobia· Intersectionality· Systemic discrimination
* Elle Lett
elle.lett@pennmedicine.upenn.edu
1 Center forApplied Transgender Studies, Chicago, IL, USA
2 Perelman School ofMedicine, University ofPennsylvania,
Blockley Hall, Philadelphia, PA19146, USA
3 Yale School ofPublic Health, NewHaven, CT, USA
4 Yale School ofMedicine, NewHaven, CT, USA
5 Department ofEpidemiology andBiostatistics, Dornsife
School ofPublic Health, Drexel University, Philadelphia, PA,
USA
6 Department ofPediatrics, Perelman School ofMedicine,
University ofPennsylvania, Philadelphia, PA, USA
7 Craig‑Dalsimer Division ofAdolescent Medicine, Children’s
Hospital ofPhiladelphia, Philadelphia, PA, USA
8 Division ofGeneral Internal Medicine, Perelman School
ofMedicine, University ofPennsylvania, Philadelphia, PA,
USA
9 Office ofInclusion, Diversity, andEquity, Perelman School
ofMedicine, University ofPennsylvania, Philadelphia, PA,
USA
10 Department ofCommunity Health Sciences, Boston
University School ofPublic Health, Boston, MA, USA
11 Division ofAdolescent/Young Adult Medicine, Boston
Children’s Hospital, Boston, MA, USA
12 Department ofBehavioral andSocial Sciences, Brown
School ofPublic Health, Providence, RI, USA
13 The Fenway Institute, Fenway Health, Boston, MA, USA
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