(P443-LB) Heterogeneity in HIV and STI outcomes among transgender and non-binary patients attending New York City Sexual Health Clinics, 2018-2022

Background: Public sexual health clinics (SHCs) are important venues for serving transgender and non-binary (TGNB) patient populations, but HIV/STI prevention, testing strategies, and outcomes often lack nuance by gender group. We sought to examine HIV/STI outcomes among a large population of TGNB patients, by gender group.



Methods: Among 2,083 TGNB patients with HIV/STI testing at the New York City SHCs between 7/1/18-12/31/22, we calculated the following outcomes: 1) HIV prevalence (newly or previously diagnosed HIV at SHCs, by self-report, or via a match against the citywide surveillance registry); 2) current PrEP use among HIV-negative patients with known PrEP status; 3) gonorrhea (GC) and chlamydia (CT) testing and positivity, by anatomic site. We used log-binomial models to examine differences in these outcomes by gender group and race/ethnicity.



Results: HIV prevalence was 15% (87/600) among transwomen, 7% (51/720) among non-binary patients assigned male at birth (AMAB), 1% (3/302) among transmen, and 0.3% (1/382) among non-binary patients assigned female at birth (AFAB) (p< 0.001). PrEP use was low: no HIV-negative, non-binary patients AFAB and 19% (126/677) of HIV-negative patients in other gender groups were taking PrEP. Compared to White TGNB patients, Black and Latinx patients had significantly higher HIV prevalence [PR (95% CI): Black, 6.86 (3.79-12.42); Latinx, 5.26 (2.91-9.51)] and lower PrEP use [PR (95% CI): Black, 0.43 (0.24-0.78); Latinx, 0.66 (0.45-0.97)]. Over 90% of patients reported oral sex; anal sex was reported by most transwomen (78%) and non-binary patients AMAB (91%), and fewer transmen (33%) and non-binary patients AFAB (27%). Three-site GC/CT testing was 60% (334/560) among transwomen, 80% (546/682) among non-binary patients AMAB, 21% (62/279) among transmen, and 7% (26/373) among non-binary patients AFAB. Anatomic site-specific GC and CT positivity did not substantially differ by gender group.

Conclusion: Higher HIV prevalence and higher levels of anal sex among transwomen and non-binary patients AMAB suggest a particular need for three-site testing in these groups. In general, HIV/STI prevention testing strategies, guided by reported sexual behavior, should be tailored to each gender group. Interventions designed to improve PrEP access and uptake should address racial inequities.