ScotTransPrep: Exploring Scottish transgender and non-binary people's knowledge and attitudes towards sexual health, HIV and preventatitve strategies
Abstract
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.