Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jun 23, 2022
Date Accepted: Jan 12, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Digital-Assisted Self-Interview of HIV/STI Risk Behaviors for Research and Clinical Care in Trans Masculine Adults: The Trans Masculine Sexual Health Assessment (TM-SHA)
ABSTRACT
Background:
The sexual health of trans masculine (TM) people – those who identify as male, men, or nonbinary and were assigned a female sex at birth – is understudied. One barrier to conducting HIV-and STI- related research with this population is how to best capture sexual risk data in a manner that is acceptable, gender-affirming, and accurate.
Objective:
The aim of this study is to report on the community-engaged process of developing, piloting, and refining a digital-deployed measure designed to assess self-reported sexual behaviors associated with HIV and STI transmission for research with TM adults.
Methods:
A multi-component process was used to develop a digital-assisted self-interview to assess HIV and STI risk in TM people. This consisted of gathering input from a community Task Force, working with an interdisciplinary team of content experts in transgender medicine, clinical epidemiology, and infectious diseases, conducting a series of online focus group discussions, and iteratively refining the measure. We field tested the measure with a sample of 141 TM individuals ages 21 to 50 years in the greater Boston Massachusetts area to assess HIV and STI risk. Descriptive statistics characterized the distribution of sexual behaviors and HIV and STI transmission risk by gender identity of sexual partners.
Results:
The Trans Masculine Sexual Health Assessment (TM-SHA) measures the broad range of potential sexual behaviors TM may engage in, including those which may confer risk for STIs and not just for HIV infection; incorporates gender-affirming language to make questions and response options less gendered and binary sex-specific (i.e., using term like ‘genital’ versus ‘vaginal’); and asks sexual partnership characteristics to understand interpersonal contexts. The 141 individual participants reported 259 sexual partnerships and 15 sexual practices (15 risk behaviors); frequency of protective barrier use ranged from 11%-81% depending on behavior. Sexual behaviors included genital-genital contact, anal sex, fingering/fisting, oral sex, and sharing toys/prosthetics during insertive sex.
Conclusions:
The TM-SHA is one of the first digital sexual health risk measures developed specifically with and exclusively for TM individuals. TM-SHA successfully integrates gender-affirming language and branching logic to capture the wide array of sexual behaviors practiced by TM people. The sexual history tool was highly acceptable to TM individuals and found to elicit the sexual behavior information needed to assess HIV and STI transmission risk behaviors. A strength of the measure is that the detailed partner-by-partner data can be utilized to model partnership-level characteristics, not just individual-level participant data, to inform interventions for HIV and STI risk behaviors in TM. Clinical Trial: ClinicalTrials.gov NCT02401867
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.