Discrimination based on gender identity and decision-making regarding HIV/STI-protected sex, a cross-sectional study among trans and non-binary people in Germany.
Gender identity
Sexual empowerment
Sexual health
Sexually transmitted Diseases/Infections
Social discrimination
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
31 Oct 2024
31 Oct 2024
Historique:
received:
17
06
2024
accepted:
18
10
2024
medline:
31
10
2024
pubmed:
31
10
2024
entrez:
31
10
2024
Statut:
epublish
Résumé
Trans and non-binary people are often discriminated against. Discrimination has a negative impact on health and may affect sexual health and behavior. We explored the relationship between discrimination based on gender identity and the perceived ability to make decisions about their sex life to feel as protected as desired from HIV and sexually transmitted infections (STI) among trans and non-binary people in Germany. Secondarily, we assessed whether feeling unable of making HIV/STI-protected sex decisions was associated with behaviors related to increased HIV/STI risk. We conducted a cross-sectional study using data from the Sexual Health and HIV/STI in Trans and Non-Binary Communities (TASG) survey conducted online between March-July 2022 among trans and/or non-binary people aged 18 years and older living in Germany. We described the prevalence of frequent discrimination based on gender identity. We calculated prevalence ratios (PR) with 95% confidence intervals (95% CI) for the associations between frequent experienced discrimination based on gender identity and feeling unable of making HIV/STI-protected sex decisions, and between feeling unable of making HIV/STI-protected sex decisions and behaviors related to increased HIV/STI risk. Among 3077 participants, 22% reported frequent discrimination based on gender identity. Participants experiencing such discrimination reported 1.4 times more often to feel unable to make HIV/STI-protected sex decisions (PR 1.4, 95% CI 1.1-1.8). This perceived inability was associated with increased prevalence of sex under drug influence (PR 2.9, 95% CI 2.3-3.7) and condomless penetrative sex with multiple partners without PrEP (PR 2.0, 95% CI 1.4-2.9). Feeling unable to make decisions to feel protected from HIV/STI among trans and non-binary people was associated with both frequent discrimination and behaviors that increase the HIV/STI risk. Strategies for empowering trans and non-binary people to assert their sexual decision-making needs should be explored.
Sections du résumé
BACKGROUND
BACKGROUND
Trans and non-binary people are often discriminated against. Discrimination has a negative impact on health and may affect sexual health and behavior. We explored the relationship between discrimination based on gender identity and the perceived ability to make decisions about their sex life to feel as protected as desired from HIV and sexually transmitted infections (STI) among trans and non-binary people in Germany. Secondarily, we assessed whether feeling unable of making HIV/STI-protected sex decisions was associated with behaviors related to increased HIV/STI risk.
METHODS
METHODS
We conducted a cross-sectional study using data from the Sexual Health and HIV/STI in Trans and Non-Binary Communities (TASG) survey conducted online between March-July 2022 among trans and/or non-binary people aged 18 years and older living in Germany. We described the prevalence of frequent discrimination based on gender identity. We calculated prevalence ratios (PR) with 95% confidence intervals (95% CI) for the associations between frequent experienced discrimination based on gender identity and feeling unable of making HIV/STI-protected sex decisions, and between feeling unable of making HIV/STI-protected sex decisions and behaviors related to increased HIV/STI risk.
RESULTS
RESULTS
Among 3077 participants, 22% reported frequent discrimination based on gender identity. Participants experiencing such discrimination reported 1.4 times more often to feel unable to make HIV/STI-protected sex decisions (PR 1.4, 95% CI 1.1-1.8). This perceived inability was associated with increased prevalence of sex under drug influence (PR 2.9, 95% CI 2.3-3.7) and condomless penetrative sex with multiple partners without PrEP (PR 2.0, 95% CI 1.4-2.9).
CONCLUSION
CONCLUSIONS
Feeling unable to make decisions to feel protected from HIV/STI among trans and non-binary people was associated with both frequent discrimination and behaviors that increase the HIV/STI risk. Strategies for empowering trans and non-binary people to assert their sexual decision-making needs should be explored.
Identifiants
pubmed: 39478507
doi: 10.1186/s12889-024-20464-2
pii: 10.1186/s12889-024-20464-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3013Subventions
Organisme : European Centre for Disease Prevention and Control
ID : EPIET Fellow
Investigateurs
Max Appenroth
(M)
Mine Pleasure Bouvar Wenzel
(MPB)
Né Fink
(N)
Silvia Rentzsch
(S)
Manuel Ricardo Garcia
(MR)
Christoph Schuler
(C)
Chris Spurgat
(C)
Heinz-Jürgen Voß
(HJ)
Informations de copyright
© 2024. The Author(s).
Références
European Commission: Directorate-General for Justice and Consumers, Brink M, Timmer A, Dunne P, Burri S. Trans and intersex equality rights in Europe : a comparative analysis. Luxembourg: Publications Office of the European Union; 2018. Available from: https://doi.org/10.2838/75428 .
European Union Agency for Fundamental Rights. LGBTI survey data explorer. 2020. https://fra.europa.eu/en/data-and-maps/2020/lgbti-survey-data-explorer . Accessed 4 Mar 2024.
Lefevor GT, Boyd-Rogers CC, Sprague BM, Janis RA. Health disparities between genderqueer, transgender, and cisgender individuals: an extension of minority stress theory. J Couns Psychol. 2019;66(4):385.
doi: 10.1037/cou0000339
pubmed: 30896208
Pascoe EA, Smart Richman L. Perceived discrimination and health: a meta-analytic review. Psychol Bull. 2009;135(4):531.
doi: 10.1037/a0016059
pubmed: 19586161
pmcid: 2747726
Krieger N. Measures of racism, sexism, heterosexism, and gender binarism for health equity research: from structural injustice to embodied harm-an ecosocial analysis. Annu Rev Public Health. 2019;41:37–62.
doi: 10.1146/annurev-publhealth-040119-094017
pubmed: 31765272
Grollman EA. Sexual health and multiple forms of discrimination among heterosexual youth. Soc Probl. 2017;64(1):156–75.
doi: 10.1093/socpro/spw031
Kosenko KA. Contextual influences on sexual risk-taking in the transgender community. J Sex Res. 2011;48(2–3):285–96.
doi: 10.1080/00224491003721686
pubmed: 20336575
Hatzenbuehler ML, Pachankis JE. Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth: research evidence and clinical implications. Pediatr Clin North Am. 2016;63(6):985–97.
doi: 10.1016/j.pcl.2016.07.003
pubmed: 27865340
Neumann MS, Finlayson TJ, Pitts NL, Keatley J. Comprehensive HIV prevention for transgender persons. Am J Public Health. 2017;107(2):207–12.
doi: 10.2105/AJPH.2016.303509
pubmed: 27997228
pmcid: 5227924
Pöge K, Dennert G, Koppe U, Güldenring A, Matthigack EB, Rommel A. The health of lesbian, gay, bisexual, transgender and intersex people. J Health Monit. 2020;5(Suppl 1):2.
pubmed: 35146279
pmcid: 8734091
Leite BO, de Medeiros DS, Magno L, Bastos FI, Coutinho C, de Brito AM, et al. Association between gender-based discrimination and medical visits and HIV testing in a large sample of transgender women in northeast Brazil. Int J Equity Health. 2021;20:1–11.
doi: 10.1186/s12939-021-01541-z
UNAIDS. HIV and transgender and other gender-diverse people. Human rights fact sheet series 2021. https://www.unaids.org/sites/default/files/media_asset/04-hiv-human-rights-factsheet-transgender-gender-diverse_en.pdf . Accessed 4 Mar 2024.
Kaltiala R, Ellonen N. Transgender identity and experiences of sexual harassment in adolescence. Child Abuse Rev. 2022;31(4): e2748.
doi: 10.1002/car.2748
Johns MM, Lowry R, Adrzejewski J, Barrios L, Demissie Z, McManus T, et al. Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. MMWR Morbidity and mortality weekly report. 2019;68:68.
doi: 10.15585/mmwr.mm6803a3
Connolly D, Aldridge A, Davies E, Maier LJ, Ferris J, Gilchrist G, Winstock A. Comparing transgender and cisgender experiences of being taken advantage of sexually while under the influence of alcohol and/or other drugs. J Sex Res. 2021;58(9):1112–7.
doi: 10.1080/00224499.2021.1912692
pubmed: 33908334
Truman JL, Morgan RE. Violent victimization by sexual orientation and gender identity, 2017–2020. US Department of Justice, Office of Justice Programs, Bureau of Justice. 2022. https://bjs.ojp.gov/library/publications/violent-victimization-sexual-orientation-and-gender-identity-2017-2020 . Accessed 24.10.2024.
Messinger AM, Koon-Magnin S. Sexual violence in LGBTQ communities. In: O'Donohue WT, Schewe PA, eds. Handbook of sexual assault and sexual assault prevention. Switzerland AG: Springer Nature; 2019. p. 661–674. https://doi.org/10.1007/978-3-030-23645-8_39 .
Monro S. Non-binary and genderqueer: an overview of the field. Int J Transgenderism. 2019;20(2–3):126–31.
doi: 10.1080/15532739.2018.1538841
Robert Koch Institute. Sexuelle Gesundheit und HIV/STI in trans und abinären Communitys. [Sexual health and HIV/STI in trans and non-binary communities]. 2022. https://www.rki.de/DE/Content/InfAZ/H/HIVAIDS/Studien/TASG.htm . Accessed 4 Mar 2024.
Robert Koch Institute and Deutsche Aidshilfe. Forschungsbericht zum Projekt "Sexuelle Gesundheit und HIV/STI in trans und nicht-binären Communitys". [Research report for the project "Sexual health and HIV/STI in trans and non-binary communities"]. 2023. Available from: https://www.rki.de/DE/Content/InfAZ/H/HIVAIDS/Studien/TASG-Ergebnisse.pdf?__blob=publicationFile .
Castro Varela MdM, Koop U, Mohamed S, Ott-Gerlach G, Thaler L. "... nicht so greifbar und doch real": Eine quantitative und qualitative Studie zu Gewalt-und (Mehrfach-) Diskriminierungserfahrungen von lesbischen, bisexuellen Frauen und Trans* in Deutschland. [ '...not so tangible and yet real' A quantitative and qualitative study on lesbian, bisexual and trans* women's experiences of violence and (multiple) discrimination in Germany]. 2012. https://lesmigras.de/wp-content/uploads/2021/11/Dokumentation-Studie-web_sicher.pdf . Accessed 24.10.2024.
ILGA-Europe. FRA LGBTI Survey II. Data disaggregation2022. Available from: https://www.ilga-europe.org/files/uploads/2022/08/FRA-LGBTI-Survey-II-data-disaggregation-tables.pdf . 2019.
James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The Report of the 2015 U.S.Transgender Survey. Washington, DC: National Center for Transgender Equality; 2016. https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf . Accessed 24.10.2024.
Worthen M. Queers, bis, and straight lies: an intersectional examination of LGBTQ stigma. Routledge; 2020.
Worthen MG. Why can’t you just pick one? The stigmatization of non-binary/genderqueer people by cis and trans men and women: an empirical test of norm-centered stigma theory. Sex Roles. 2021;85(5):343–56.
doi: 10.1007/s11199-020-01216-z
Skuban-Eiseler T, Orzechowski M, Steger F. Why do transgender individuals experience discrimination in healthcare and thereby limited access to healthcare? An interview study exploring the perspective of German transgender individuals. Int J Equity Health. 2023;22(1):211.
doi: 10.1186/s12939-023-02023-0
pubmed: 37817187
pmcid: 10566060
Fontenot HB, Cahill SR, Wang T, Geffen S, White BP, Reisner S, et al. Transgender youth experiences and perspectives related to HIV preventive services. Pediatrics. 2020;145(4):e20192204.
doi: 10.1542/peds.2019-2204
pubmed: 32184336
Sevelius J. There’s no pamphlet for the kind of sex I have: HIV-related risk factors and protective behaviors among transgender men who have sex with nontransgender men. J Assoc Nurses AIDS Care. 2009;20(5):398–410.
doi: 10.1016/j.jana.2009.06.001
pubmed: 19732698
pmcid: 2785444
Hatzenbuehler ML, Link BG. Introduction to the special issue on structural stigma and health. Soc Sci Med. 2014;103:1–6.
Anzani A, Lindley L, Tognasso G, Galupo MP, Prunas A. Being talked to like I was a sex toy, like being transgender was simply for the enjoyment of someone else: fetishization and sexualization of transgender and nonbinary individuals. Arch Sex Behav. 2021;50(3):897–911.
doi: 10.1007/s10508-021-01935-8
pubmed: 33763803
pmcid: 8035091
Blair KL, Hoskin RA. Transgender exclusion from the world of dating: patterns of acceptance and rejection of hypothetical trans dating partners as a function of sexual and gender identity. J Soc Persona Relationships. 2019;36(7):2074–95.
doi: 10.1177/0265407518779139
Scandurra C, Mezza F, Maldonato NM, Bottone M, Bochicchio V, Valerio P, Vitelli R. Health of non-binary and genderqueer people: a systematic review. Front Psychol. 2019;10: 1453.
doi: 10.3389/fpsyg.2019.01453
pubmed: 31293486
pmcid: 6603217
Leung MW, Yen IH, Minkler M. Community based participatory research: a promising approach for increasing epidemiology’s relevance in the 21st century. Int J Epidemiol. 2004;33(3):499–506.
doi: 10.1093/ije/dyh010
pubmed: 15155709