Latent Constructs of Economic Marginality Associated with Sexual Behavior, Healthcare Access and HIV Outcomes Among Transgender and Nonbinary People in Three U.S. Cities.

Transgender and nonbinary people (TNB) in the U.S. experience high HIV prevalence and diverse economic hardships. Yet a comprehensive understanding of how multiple, simultaneously occurring hardships-termed economic marginality-are together associated with healthcare and HIV outcomes is needed. Leveraging survey data from a sample of 330 TNB people in three U.S. cities, we conducted an exploratory mixed-source principal component analysis of latent factors of economic experience, then estimated their associations with sexual behavior, access to healthcare, HIV status, and HIV testing frequency. Two factors emerged: a traditional socioeconomic factor related to income, education, and employment (SES), and one related to housing precarity and (lack of) assets (Precarity). Higher Precarity scores were associated with sexual behavior, cost-based healthcare avoidance, discrimination-based healthcare avoidance, and more frequent HIV testing. Findings highlight the importance of understanding profiles of economic marginalization among trans and nonbinary people and can inform efforts to address upstream, structural factors shaping healthcare access and HIV outcomes in this key population.

Attitudes Toward the Uptake of Combination HIV Prevention Methods Among Young Black and Latino Heterosexual Couples Living in New York City: A Qualitative Study.

ABSTRACT: Couple-based HIV interventions that increase uptake of two or more effective biomedical HIV prevention methods may be a promising HIV prevention strategy for young Black and Latino heterosexual couples. We conducted in-depth, semi-structured individual interviews with 23 Black and Latino adolescent and young adult heterosexual couples that explored their attitudes toward using combination HIV prevention methods (CHPMs). A qualitative hybrid thematic analysis approach was used to identify key themes. Themes included: (a) attitudes that encouraged uptake-CHPMs increased assurance of safety against HIV/sexually transmitted infections and (b) attitudes that impeded uptake-CHPMs are too much to do and are not appropriate for serious relationships. Although Black and Latino adolescents and young adults may recognize the combined protective benefits of using multiple HIV prevention methods, personal and relational considerations play an instrumental role in uptake of CHPMs.

Application of the unified theory of behavior to strengthen sexual health discussions between providers and young patients in the United States.

CONTEXT: Sexual health discussions between healthcare providers and adolescent and young adult patients are an important strategy for addressing and improving sexual health. However, healthcare providers often do not engage in comprehensive sexual health discussions with young patients during routine clinical visits. METHODS: We propose the use of a conceptual model, the Unified Theory of Behavior (UTB), as a tool that can aid healthcare providers in facilitating more comprehensive sexual health conversations with young patients. RESULTS: We present clinical scenarios on how healthcare providers can use the UTB with existing sexual health assessments during routine, clinical visits with their patients. CONCLUSIONS: Using the UTB may be one effective tool to aid healthcare providers in initiating sexual health discussions and facilitating more comprehensive sexual health conversations with adolescent and young adult patients during routine clinical visits and sexual and reproductive health-focused visits.