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AIDS Patient Care STDS. 2019 Mar;33(3):120-130. doi: 10.1089/apc.2018.0249.

Situated Vulnerabilities, Sexual Risk, and Sexually Transmitted Infections' Diagnoses in a Sample of Transgender Youth in the United States.

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1 Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
2 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
3 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
4 The Fenway Institute, Fenway Health, Boston, Massachusetts.
5 Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan.
6 Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts.


In the United States, sexually transmitted infections (STIs) confer significant morbidity in adolescents and young adults. STIs are not well characterized in transgender and other gender minority youth (TGMY) who have a gender identity that differs from the sex assigned to them at birth. This study sought to fill this gap. In 2015-2016, the Adolescent Medicine Trials Network for HIV/AIDS Interventions conducted Protocol 130, Affirming Voices for Action, enrolling a diverse sample of TGMY 16-24 years of age from 14 US geographic locations. Multivariable analyses regressed lifetime STI diagnosis on "situated vulnerabilities" (demographics, social/economic issues, mental/behavioral health conditions, and health care experience). Approximately one-third were living with HIV infection (31%); 33% had a history of one or more STIs, excluding HIV. The most frequently diagnosed STIs were 55% chlamydia, 48% syphilis, and 47% gonorrhea. The odds of STI was 4.06 times higher for trans feminine youth assigned a male sex at birth compared to trans masculine youth assigned a female sex at birth (p = 0.03). Additional risk factors for lifetime STI were as follows: nonbinary gender identity (p = 0.004), medical gender affirmation (p = 0.03), and transactional sex (p = 0.01). Nearly one-third (31%) reported condomless vaginal and/or anal sex in the last 6 months, suggesting a need for ongoing STI prevention, screening, diagnosis, and treatment. TGMY are a vulnerable group to STIs in need of public health attention. Clinical care for STIs will benefit from considering risk factors facing youth in general (e.g., sex work), alongside those vulnerabilities unique to TGMY (e.g., medical gender affirmation).


gender minority; sexually transmitted infections; transgender; youth

[Available on 2020-03-01]

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