Large numbers of transgender MSM have never tested for HIV or STIs

Image: The Gender Spectrum Collection. Image is for illustrative purposes only.

A substantial minority of transgender men who have sex with men (MSM) have never tested for HIV or been screened for sexually transmitted infections (STIs), according to US research published in the online edition of Sexually Transmitted Infections. High-risk anal sex was associated with never testing for HIV.

Overall, 28% of trans MSM recruited to the study had never been screened for HIV and 39% had not had an HIV test in the previous 12 months. The US Centers for Disease Control and Prevention (CDC) recommend that gay and other MSM should be tested for HIV at least once a year, but the study shows that trans MSM have screening levels well below recommended standards.

“These findings highlight the importance of reaching transgender men who have sex with men and improving routine HIV and STI testing in this population,” write the authors.



An umbrella term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth.

cisgender (cis)

A person whose gender identity and expression matches the biological sex they were assigned when they were born. A cisgender person is not transgender.

risky behaviour

In HIV, refers to any behaviour or action that increases an individual’s probability of acquiring or transmitting HIV, such as having unprotected sex, having multiple partners or sharing drug injection equipment.

adjusted odds ratio (AOR)

Comparing one group with another, expresses differences in the odds of something happening. An odds ratio above 1 means something is more likely to happen in the group of interest; an odds ratio below 1 means it is less likely to happen. Similar to ‘relative risk’. 


Having sex without condoms, which used to be called ‘unprotected’ or ‘unsafe’ sex. However, it is now recognised that PrEP and U=U are effective HIV prevention tools, without condoms being required. Nonethless, PrEP and U=U do not protect against other STIs. 

Studies conducted in cities such as New York have shown suboptimal levels of HIV and STI screening among transgender MSM, but there are few national studies on this subject. Another recent US-wide study found that almost a quarter of trans people at risk of acquiring HIV through sex with cisgender men and/or trans women had never tested for HIV, and 54% did not meet CDC recommendations for HIV testing once a year or more often.

Dr Nadav Antebo-Gruzka of Columbia University, New York, and his co-investigators therefore designed a study involving transgender MSM recruited across the US to determine lifetime rates of HIV and STI testing and prevalence of HIV testing in the past year. The researchers also examined the sociodemographic and behavioural factors associated with HIV and STI screening.

Their study population consisted of 192 transgender men MSM who took part in a larger survey conducted in 2017 with almost 13,000 gay and other MSM. Recruitment was open to cisgender and transgender adult men who reported sex with another man in the previous year. Participants were recruited through targeted ads on a gay hook-up app and Facebook.

Over two-thirds (71%) of the transgender men were White; 53% identified as gay/queer/homosexual and 38% as bisexual. Approximately two-thirds had an annual income below $20,000 and mean age was 24 years. Two per cent reported that they were HIV positive, with 12% stating they were unaware of their HIV status. HIV transmission risk behaviour – condomless anal sex with a man of different or unknown HIV status – was reported by a third, while half reported that they had had fewer than two casual male partners in the past six months.

Ever testing for HIV was reported by 71% of transgender men, markedly lower than the 89% prevalence reported by cisgender men. Over two-thirds of transgender men reported ever testing for bacterial STIs (67%) and viral STIs (71%), rates that were once again lower than those observed in cisgender men (77% and 76%, respectively).

However, there was no difference in HIV testing within the past 12 months – 61% of transgender men and 62% of cisgender men.

"High-risk anal sex was associated with never testing for HIV."

HIV transmission risk behaviour was associated with a 70% reduction in the odds of ever testing for HIV (aOR = 0.30; 95% CI, 0.12-0.79), a 67% reduction in the odds of ever testing for bacterial STIs (aOR = 0.33; 95% CI, 0.14-0.76) and a 57% reduction in the odds of ever been screen for a viral STI (aOR = 0.43; 95% CI, 0.19-0.99).

As regards HIV testing in the past year, transmission risk behaviour was once again associated with a reduction in the odds of screening (aOR = 0.45; 95% CI, 0.20-0.97).

Having fewer than two casual sexual partners was also associated with lower odds of screening for HIV and STIs, as was younger age and living in southern states compared to other regions of the US.

Dr Antebi-Gruszka and his colleagues believe the study has four key messages:

  • Levels of HIV and STI screening among transgender men who have sex with men are suboptimal.
  • There is a need for greater uptake of HIV and STI testing among both transgender and cisgender gay and other MSM.
  • Efforts to increase screening are especially warranted for transgender MSM who have condomless anal sex.
  • HIV and STI testing could be incorporated into broader health initiatives for transgender gay and other MSM.

“The most noteworthy finding is the lower prevalence of past year and lifetime HIV testing, as well as lifetime STI testing, found among those transgender MSM who engage in HIV risk behaviour,” write the authors. “Comparing the transgender MSM subsample with the broader MSM sample in this study, more MSM reported not knowing their HIV status, which is related to lower lifetime HIV testing prevalence found in this substudy.”


Antebi-Gruszka N et al. Sociodemographic and behavioural factors associated with testing for HIV and STIs in a US nationwide sample of transgender men who have sex with men. Sexually Transmitted Infections, online edition ahead of print, 30 June 2020.

doi: 10.1136/sextrans-2020-054474