DOI
https://doi.org/10.25772/PDF2-5A69
Author ORCID Identifier
https://orcid.org/0009-0008-5778-472X
Defense Date
2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Healthcare Policy & Research
First Advisor
April Kimmel
Second Advisor
An Pham
Third Advisor
Emmanuel A. Taylor
Fourth Advisor
Bassam Dahman
Abstract
This dissertation examines the roles of gender identity, healthcare experience, and practitioners' scope of healthcare services in the uptake of annual HIV screening among the understudied population of transgender individuals. Transgender individuals are about half as likely to have an annual HIV screening despite having similar risk profiles to men who have sex with men (MSM). The current HIV guidelines for MSM recommend annual HIV screening because of the risky sexual practice, anal sex with other men. Similar to MSM, transgender individuals who have anal sex with men are at higher risk than the general population for HIV acquisition because of their continuous engagement in anal sex with men. Increasing transgender-specific healthcare knowledge among practitioners may lead to the inclusion of transgender individuals in standardized HIV screening guidelines, lessen negative healthcare engagement experiences, and broaden practitioners’ healthcare scope, all of which may increase HIV screening among high-risk (i.e., engaging in receptive anal sex) transgender individuals. In the first investigation, we seek to understand if there are HIV screening differences among communities with similar risk profiles (engaging in receptive anal sex), specifically MSM versus transgender individuals. In the second and third investigation, we seek to understand possible contributors associated with HIV screening behaviors of transgender individuals with high-HIV-acquisition risk. This dissertation addresses 3 research questions:
1) Is there a relationship between gender identity and annual HIV screening among high-risk transgender individuals?
2) Is there a relationship between healthcare experience and annual HIV screening among high-risk transgender individuals?
3) Is there a relationship between practitioners' scope of healthcare services and annual HIV screening among high-risk transgender individuals?
Our findings suggest that despite having a similar high-risk profile (engaging in receptive anal sex), when compared to MSM, transgender individuals were less likely to have an annual HIV screening. Furthermore, transgender individuals who received primary care services in the past 12 months had a higher likelihood of having an annual HIV test. These findings suggest that being transgender and having high-HIV-acquisition risk (i.e., receptive anal sex with men) may impact annual HIV screening uptake, but their odds of having an annual HIV screening are higher when involved with primary care services. However, when examining the relationship between healthcare experience and annual HIV screening, we found no significant relationships. Furthermore, high-risk transgender individuals whose practitioners’ scope of services includes both trans-related and routine healthcare (versus routine healthcare only) were more likely to have an annual HIV screening, suggesting that when treating high-risk transgender individuals, the scope of the practitioner may impact the rate of HIV screening. Further work in this field includes developing, testing and evaluating survey questions that explicitly address sexual practices in order to isolate high-HIV-acquisition-risk (i.e., engaging in receptive anal sex) populations, as well as, developing survey questions with clear distinctions between healthcare provider types.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-6-2025