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

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.