HIV testing among transgender and non-binary individuals in Canada

Transgender and non-binary populations experience sexual health inequities, including increased risk of HIV acquisition and barriers to accessing sexual healthcare. However, there is little evidence describing HIV testing prevalence among this population in Canada. This study analyzed data from Trans PULSE Canada, a national convenience sampling health survey of transgender and non-binary people, to assess the prevalence and predictors of HIV testing. Data from 679 participants who reported past-year condomless anal or vaginal sex with a partner were analyzed to evaluate lifetime and past-year HIV testing. Exploratory block-wise modified Poisson regression models were used to identify predictors of past-year testing. Overall, 62% of participants had ever been tested for HIV, and 33% had been tested in the past year. Participants who were single or in non-monogamous relationships (vs. monogamous) were more likely to have been tested in the past year (adjusted prevalence ratio [aPR]: 2.15, 95% CI [1.57, 2.94], and aPR: 2.43, 95% CI [1.81, 3.28], respectively), as were those who reported past-year in-person sex work (aPR: 1.83, 95% CI [1.39, 2.40]). Past-year testing did not significantly differ across sociodemographic, personal health, primary care, gender affirmation, or discrimination variables. HIV testing estimates were low among transgender and non-binary individuals at sexual risk of HIV acquisition in Canada relative to national testing guidelines. The likelihood of past-year testing was similar across most subgroups of transgender and non-binary participants. Encouragingly, indicators of greater HIV-related sexual risk were associated with a higher likelihood of past-year testing.