Correlates of STI Uptake and Diagnoses among Transfeminine People Restricted; Files & ToC

Abstract

Background

Transgender women and transfeminine people are disproportionately affected by sexually transmitted infections (STIs). This study investigated demographic, socio-economic, and health-related factors influencing STI testing behaviors in this priority population.

 

Methods

We collected data from 3,314 transfeminine people across the U.S. through the Transgender Women’s Internet Survey and Testing study, from June 2022 to October 2023. Participants were assessed on various factors including age, race, education, income, healthcare access, behavioral habits (condom use, HIV PrEP usage), and psychosocial factors (depression). We used multivariable Poisson regression with robust variances to estimate prevalence ratios (PRs) with 95% confidence intervals (CIs) for factors associated with STI testing.

 

Results

The average participant age was 30.4 years, with many participants in the priority age group comprising 15-24 year olds (34.0%). Most participants were non-Hispanic white (73.0%), had some college education or higher (72.9%), and were employed (75.7%). Older participants aged 30-39 (PR=1.31, 95%CI: 1.18, 1.45) and aged 40 or older (PR=1.19, 95%CI: 1.06, 1.34) were more likely to ever have an STI test compared to those aged 15­–24 years. STI testing within the past year was also more likely among those who visited a healthcare provider (PR=1.63, 95%CI: 1.28, 2.06), were on hormonal therapy (PR=1.23, 95%CI: 1.03, 1.46), and used HIV PrEP (PR=2.33, 95%CI: 2.09, 2.61). Condom use during sexual activity was also linked to increased testing (PR=1.12, 95%CI: 1.05, 1.20 for vaginal sex; PR=1.14, 95%CI: 1.06, 1.22 for anal sex). Conversely, lower education (PR=0.69, 95%CI: 0.61, 0.77 for high school or less) and symptoms of depression (PR=0.89, 95%CI: 0.83, 0.96) were negatively associated with testing. No significant correlations were found with race, employment, income, insurance status, and substance use.

 

Discussion

We identified correlates of STI testing among transfeminine people including age, education, use of hormonal therapy, and HIV prevention measures. The negative association of depressive symptoms with STI testing emphasizes the importance of mental health support in promoting healthcare utilization. The results suggest that interventions should be specifically designed to address the needs and barriers faced by transfeminine people to reduce health disparities and improve sexual health outcomes.

Table of Contents

This table of contents is under embargo until 20 May 2026

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Parola chiave	Transgender Health STI Testing Transfeminine Health
Committee Chair / Thesis Advisor	Jeb Jones, Emory University

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