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Transgender and nonbinary (TNB) individuals experience a variety of systemic barriers that impact their ability to access healthcare, often leading to negative health outcomes. Previous research has suggested that improving health literacy among marginalized communities may help reduce existing health disparities. Yet few studies have examined health literacy among TNB people and how health literacy and healthcare access may differ by urbanicity. Using the capabilities theoretical approach, the current study uses data from six focus groups (N =40) from metropolitan, urban, and rural areas in Colorado to examine geographic differences in health literacy and healthcare access. Findings show that geographic differences in accessing healthcare include transportation issues, having to travel far distances to access care, finding a TNB-affirming and competent provider, and needing to educate providers and staff. These differences were more prevalent among TNB people living in non-metropolitan areas. Additionally, our findings suggest that TNB individuals have high levels of health literacy due to having to self-educate and exist within a healthcare system that was designed for cisgender people. [ABSTRACT FROM AUTHOR]

Objective: A syndemic of violence exposure, substance misuse, and mental health problems (i.e., depression, anxiety, posttraumatic stress disorder) is associated with increased unprotected anal sex and number of sexual partners in young men who have sex with men (YMSM). However, few studies have examined multiple forms of violence—including childhood abuse, intimate partner violence, and community violence—and identified which factors are significant predictors of HIV risk for YMSM when controlling for all other factors. Accordingly, this study examined the additive and independent influence of different forms of violence, substance misuse, and mental health problems associated with sexual risk behaviors in YMSM who used HIV prevention services. Method: A convenience sample of 168 (97 Black or multiethnic Black, 71 white) YMSM ages 18–34 completed computer-assisted personal interviews assessing syndemic factors and HIV risk behaviors. We conducted Spearman correlations and negative binomial regressions to describe syndemic relationships and identify the significant independent predictors of HIV risk. Results: A syndemic of violence exposure, substance use, and mental health problems was observed in the sample. Also, participants with depression, drug abuse in the clinical range, and polydrug use reported significantly higher frequencies of sexual risk behaviors. Violence exposure did not uniquely predict sexual risk. Conclusions: Depression, drug abuse, and polydrug use should be targets for HIV prevention among YMSM using HIV prevention services. [ABSTRACT FROM AUTHOR]

Background and Objectives: Lesbian, gay, bisexual, and questioning (LGBQ) youth are at greater risk of problematic alcohol use than their heterosexual peers, yet there is a dearth of research examining variability in alcohol use among youth that simultaneously accounts for sexual orientation and gender identity. This paper examines the relationship between alcohol use and intersecting identities of sexual orientation and gender while accounting for this population's disproportionate experiences of depression and dating and sexual violence. Methods: The study used a representative sample (n = 27,621) of high school students. Logistic regressions were used to determine if earlier age at first drink, 30‐day alcohol use, and binge drinking were significantly related to intersectional sexual orientation and gender identity. Secondary models added depression, dating violence, and sexual violence to analyses to determine if they explained any of the variance in alcohol use variables in LGBQ and transgender youth. Results: Transgender youth who identified as heterosexual or questioning their sexual orientation were at greatest risk for early initiation of alcohol use and binge drinking. These relationships between intersectional identity and alcohol use became nonsignificant when depression, dating violence, and sexual violence were added to the models. Conclusions and Scientific Significance: This is the first study to examine relationships between intersecting identities of sexual orientation and gender identity and alcohol use among youth. Risky alcohol use among transgender youth may be attributed to experiences of depression, dating violence, and sexual violence impacting these populations. Interventions should focus on reducing transgender youth exposure to violence. [ABSTRACT FROM AUTHOR]

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 [χ 2 (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.