“It’s a Big Ordeal”: A Mixed Methods Study of the Experiences of non-HIV STI Testing Among Trans and Gender Diverse People

Transgender and gender diverse (TGD) persons are disproportionately affected by sexually transmitted infection (STI) inequities. Research predominantly focuses on HIV disparities among transfeminine persons, whereas non-HIV STIs (e.g., chlamydia) and transmasculine and nonbinary persons are overlooked. Thus, we examined barriers and facilitators to uptake of non-HIV STI testing among TGD persons, inclusive of transmasculine, transfeminine, and nonbinary persons. This community-based explanatory sequential mixed-methods study utilized secondary quantitative data collected 2018-2019 from the Michigan Trans Health Survey (n = 528) analyzed utilizing logistic regression to test associations between social ecological hypothesized factors and non-HIV STI testing. Primary qualitative focus group data collected 2022 (n = 36 TGD participants) were analyzed using a reflexive thematic approach. In multivariable analyses adjusting for age and race, reporting a very/somewhat inclusive primary care provider and ever experiencing sexual violence were statistically significantly positively associated with testing. Five themes were identified that illustrated the complexity of the testing process: 1) The "why" motivating testing; 2) "I've been vocal": The impact of individual agency on TGD peoples' testing practices; 3) "It's a big ordeal": Running the gauntlet of testing; 4) "Doesn't give me a hassle": Gratitude for bare minimum dignity when accessing care; and, 5) "Open, honest, and transparent": Increased testing access due to collaborative, judgment-free, and trustworthy patient-provider relationships. Findings inform future interventions to increase STI testing among TGD populations, such as enhanced trauma-informed, intersectional, and gender-affirming STI testing, across urgent care, sexual and reproductive healthcare, and primary care. Findings call for systems-level change to promote such care to increase STI testing and advance health equity among TGD populations.