ScotTransPrep: Exploring Scottish transgender and non-binary people's knowledge and attitudes towards sexual health, HIV and preventatitve strategies
Introduction Transgender people and those with a non-binary gender identity suffer multiple societal disadvantages that impair their ability to access adequate healthcare, including in sexual health and HIV prevention, and globally are 49x more likely than the general population to be HIV positive. This study aimed to qualitatively identify knowledge about sexual health, barriers to access experienced by Scottish trans/non-binary (T/NB) people, and their suggestions for improvement. Method The author conducted six semi-structured interviews with T/NB Scottish adults, recruited in person, via social media and sociosexual apps, and thematically analysed data through an intersectional feminist advocational lens, and using a modified Integrative Behaviour Model (Wood et al 2016). Findings Participants were generally well informed regarding identifying their own sexual health needs, and about HIV prevention including PrEP. However, significant barriers, including stigma about trans identities and sexual behaviours, non-inclusively designed services, undertrained staff, financial and time constraints, community behavioural norms, mental health comorbidity, and prioritisation of gender affirming care over sexual health prevented people from accessing care. Concerns about NHS mismanagement and maltreatment have led many to seek private healthcare, paving the way for a two-tier system and worsened inequalities. Suggestions for improvement by participants included dedicated transgender sexual health clinics with staff training, community re-education, and more investment in adequate, timely access to NHS gender care. Conclusions To achieve the above suggestions and improve T/NB health, they argued that sexual health services must be better funded, and substantially and visibly trans-inclusive. Ideally targeted services will be trans-led or with substantive trans community input, and adopt an intersectional approach that bolsters the most vulnerable. T/NB people cannot achieve optimal health and wellbeing without support from healthcare staff and the wider community, including access to gender-affirming care.