Diana M Tordoff1, Sahar Zangeneh1,2, Christine M Khosropour1, Sara N Glick3, Raymond Scott McClelland1,3,4, Dobromir Dimitrov2, Sari Reisner1,5, Ann Duerr2,4. 1. Department of Epidemiology, University of Washington, Seattle, WA. 2. Fred Hutchinson Cancer Research Center, Seattle, WA. 3. School of Medicine, University of Washington, Seattle, WA. 4. Department of Global Health, University of Washington, Seattle, WA. 5. Departments of Medicine and Epidemiology, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, MA; and.
Abstract
BACKGROUND: Transgender and nonbinary (TNB) populations are disproportionately affected by HIV and few local health departments or HIV surveillance systems collect/report data on TNB identities. Our objective was to estimate the prevalence of HIV testing among TNB adults by US county and state, with a focus on the Ending the HIV Epidemic (EHE) geographies. METHODS: We applied a Bayesian hierarchical spatial small area estimation model to data from the 2015 US Transgender Survey, a large national cross-sectional Internet-based survey. We estimated the county- and state-level proportion of TNB adults who ever tested or tested for HIV in the last year by gender identity, race/ethnicity, and age. RESULTS: Our analysis included 26,100 TNB participants with valid zip codes who resided in 1688 counties (54% of all 3141 counties that cover 92% of the US population). The median county-level proportion of TNB adults who ever tested for HIV was 44% (range 10%-80%) and who tested in the last year was 17% (range 4%-44%). Within most counties, testing was highest among transgender women, black respondents, and people aged ≥25 years. HIV testing was lowest among nonbinary people and young adults aged <25 years. The proportion of TNB adults who tested within the last year was very low in most EHE counties and in all 7 rural states. CONCLUSIONS: HIV testing among TNB adults is likely below national recommendations in the majority of EHE geographies. Geographic variation in HIV testing patterns among TNB adults indicates that testing strategies need to be tailored to local settings.
BACKGROUND: Transgender and nonbinary (TNB) populations are disproportionately affected by HIV and few local health departments or HIV surveillance systems collect/report data on TNB identities. Our objective was to estimate the prevalence of HIV testing among TNB adults by US county and state, with a focus on the Ending the HIV Epidemic (EHE) geographies. METHODS: We applied a Bayesian hierarchical spatial small area estimation model to data from the 2015 US Transgender Survey, a large national cross-sectional Internet-based survey. We estimated the county- and state-level proportion of TNB adults who ever tested or tested for HIV in the last year by gender identity, race/ethnicity, and age. RESULTS: Our analysis included 26,100 TNB participants with valid zip codes who resided in 1688 counties (54% of all 3141 counties that cover 92% of the US population). The median county-level proportion of TNB adults who ever tested for HIV was 44% (range 10%-80%) and who tested in the last year was 17% (range 4%-44%). Within most counties, testing was highest among transgender women, black respondents, and people aged ≥25 years. HIV testing was lowest among nonbinary people and young adults aged <25 years. The proportion of TNB adults who tested within the last year was very low in most EHE counties and in all 7 rural states. CONCLUSIONS: HIV testing among TNB adults is likely below national recommendations in the majority of EHE geographies. Geographic variation in HIV testing patterns among TNB adults indicates that testing strategies need to be tailored to local settings.
Authors: Ansley Lemons; Linda Beer; Teresa Finlayson; Donna Hubbard McCree; Daniel Lentine; R Luke Shouse Journal: Am J Public Health Date: 2017-11-21 Impact factor: 9.308
Authors: Jeffrey S Becasen; Christa L Denard; Mary M Mullins; Darrel H Higa; Theresa Ann Sipe Journal: Am J Public Health Date: 2018-11-29 Impact factor: 9.308
Authors: Diana M Tordoff; Brian Minalga; Bennie Beck Gross; Aleks Martin; Billy Caracciolo; Lindley A Barbee; Jennifer E Balkus; Christine M Khosropour Journal: Sex Transm Dis Date: 2022-02-01 Impact factor: 2.830