Assessing the HIV prevention needs of transgender men and non-binary people who have sex with men: an analysis of repeated, cross-sectional behavioural surveillance, 2019–2023

Background The HIV-related needs of transgender and gender diverse (TGD) people who have sex with men in Australia are under-researched, impeding the effective use and targeting of HIV and sexual health services. Methods We used behavioural surveillance data to compare transgender men, non-binary people, and cisgender men on a range of factors, including demographics, sexual health, and the use of HIV testing and prevention. All eligible participant responses from the Gay Community Periodic Surveys (repeated, community-based, cross-sectional surveys) in 2019–2023 were included. Multivariable multinomial logistic regression was used to compare the groups. Results The survey included 41,883 survey responses (2.3% from transgender men and 2.7% from non-binary people). Compared with cisgender men, transgender men and non-binary people were younger, more likely to identify as bisexual or queer (than gay), and less likely to have a university degree or to be employed full-time. Transgender men were more likely to have never tested for HIV (31.8% vs 9.0%) and to not be using pre-exposure prophylaxis (PrEP; 74.2% vs 56.6%) compared to cisgender men. Non-binary people were more likely than cisgender men to have never tested for HIV (19.9% vs 9.0%), as likely as cisgender men to have tested in the past year (60.0% vs 63.9%), and similarly likely to be on PrEP (23.9% vs 30.8%). Conclusions Encouraging HIV testing and PrEP uptake among transgender men and non-binary people could help improve HIV prevention coverage in these population groups. Free or low-cost services that are gender inclusive may be particularly important for gender diverse people on lower incomes.