Gender-Affirming Hormone Therapy Is Associated with Increased Odds of Screening for Sexually Transmitted Infections in a Clinical Cohort of Transgender and Nonbinary Adults

Purpose: Transgender and nonbinary adults (TNB) are disproportionately burdened by sexually transmitted infections (STI) and the human immunodeficiency virus (HIV). This study investigated whether gender-affirming hormone therapy was associated with TNB adults' odds of screening for STI and HIV.Methods: Longitudinal data came from the electronic medical records of TNB primary care patients receiving care at two community health centers located in Boston, Massachusetts, and New York City, New York, between January 2013 and December 2019. Missing data were addressed using multiple imputation with chained equations, and statistical analyses included the use of unadjusted and covariate-adjusted logistic generalized estimating equation models. Models examined whether gender-affirming hormone therapy was significantly associated with patients' concurrent odds of STI and HIV screening between 2016 and 2019 (i.e., patients screening within the same year they had an active hormone prescription).Results: Gender-affirming hormone therapy was associated with statistically significant higher odds of STI screening (chlamydia and gonorrhea), but not HIV screening, among TNB patients (STI screening: adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI] = [1.05, 1.49]; HIV screening: aOR = 1.21, 95% CI = [1.00, 1.47]). Additionally, taking preexposure prophylaxis (PrEP) for HIV prevention was associated with increased odds of both STI and HIV screening (STI screening: aOR = 3.74, 95% CI = [1.82, 7.71]; HIV screening: aOR = 4.41, 95% CI = [2.25, 8.64]).Conclusion: Primary care appointments for the provision of gender-affirming hormones may be an opportune time to incorporate routine STI/HIV screening for sexually active TNB patients. The provision of gender-affirming hormone therapy and PrEP may increase patients' odds of routine STI/HIV screening.