title: Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males.
abstract: Female-to-male trans masculine adults who have sex with cisgender (non-transgender) males (TMSM) represent an understudied population in relation to HIV/sexually transmitted infection (STI) risk. This study examined the role of syndemic conditions and social gender affirmation processes (living full-time in one's identified gender) in potentiating sexual risk among TMSM adults in Massachusetts, US. Cross-sectional data were restricted to TMSM who reported lifetime sexual behaviour with a cisgender male (n = 173; mean age = 29.4, SD = 9.6; 18.5% people of colour; 93.1% non-heterosexual identity; 56.1% hormones/surgery). Sexual risk outcomes were: lifetime STI diagnoses, three or more sexual partners in the previous six months, and condomless anal/vaginal sex at last encounter with a cisgender male. Age- and survey mode-adjusted logistic regression models regressed sexual risk outcomes on the main effect of syndemics (six indicators summed: binge drinking, substance use, depression, anxiety, childhood abuse, intimate partner violence), followed by the interaction of syndemics and social gender affirmation. Syndemics were associated with increased odds of all sexual risk indicators (adjusted odds ratios [aORs] = 1.32-1.55; p < 0.0001). Social gender affirmation moderated the association between syndemics and condomless anal/vaginal sex at last encounter with a cisgender male (p < 0.0001). Syndemics were associated with sexual risk in TMSM who had socially affirmed their gender (aOR = 1.79; 95% CI = 1.42-2.25; p < 0.001), but not among those TMSM who had not (aOR = 0.86; 95% CI = 0.63-1.19; p = 0.37). Findings suggest that syndemic pathways to sexual risk are similar for TMSM who have socially gender affirmed as for cisgender MSM. Integration of syndemics and gender affirmation frameworks is recommended in interventions to address TMSM sexual risk.
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA The Fenway Institute, Fenway Health, Boston, MA, USA sreisner@fenwayhealth.org.
authors.forename: Sari L
authors.initials: SL
authors.lastname: Reisner
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
authors.forename: Jaclyn M
authors.initials: JM
authors.lastname: White Hughto
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Pardee
authors.affiliation: Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA.
authors.forename: Jae
authors.initials: J
authors.lastname: Sevelius
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012747:Sexual Partners; D012959:Socioeconomic Factors; D063106:Transgender Persons; D014189:Transsexualism / Q000523:psychology*; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult; D005260:Female
keywords: HIV/STI risk; TMSM; Transgender; gender affirmation; syndemics