2091. Transgender Adolescents of Color and HIV: Unique Challenges in Preventing New Infections


 
 
 An estimated HIV prevalence of 9.2% for all transgender persons nationally with a significantly higher prevalence for transgender women at 14.1%. A paucity of published data exists defining the risk of HIV in transgender or non-binary (TGNB) youth of color. The Bronx has the highest incidence of homelessness and the highest unemployment rate in the country, which peaked at 24.6% during COVID19. We assessed SDOH in TGNB youth of color and the impact on their ability to prioritize and access HIV prevention.
 
 
 
 An assessment of sexually active TGNB youth 14-27 years (N=101) in 2021-2022 was conducted to evaluate potential barriers to HIV prevention by querying the 4 U's: 1) Unemployed 2) Uninsured / Underinsured 3) Unstable housing and 4) substance Use disorder. The assessment also integrated questions about gender affirmation, HIV / STI prevention. Information obtained was used to assess knowledge gaps that affect their understanding of HIV risk. Based on the results, a research tool, ARTISTA (Assess Risk for Transmitted Infections in Sexually active Transgender Adolescents) was implemented to improve gaps in understanding HIV / STI risk in TGNB youth. Ultimately, ARTISTA can be used to influence policies for HIV Prevention in this population.
 
 
 
 Patient's mean (+sd) age was 20 (+ 2.7) years, 50% were trans female, 50% trans male, 66% were youth of color. Gender affirming care was associated with increased odds of STI testing (adjusted odds ratio = 1.90 95% confidence interval = 1.33-2.73 with no relation to gender identity. Despite awareness, initiation of PrEP and adherence among trans females was disappointing. Trans females, 24%(10/41) initiated PrEP, 2 seroconverted; 1 stopped and 7 are 70% adherent to daily oral PrEP. Unemployment (23%), Unstable housing (11%), Uninsured (10%) and Substance Use disorder (40%) were priorities over prevention.
 
 
 
 Gender affirmation is associated with an opportunity to improve awareness of HIV / STI prevention. ARTISTA assessment reveals it's not just about PrEP, but about the social / structural barriers to access and uptake. SDOH must be addressed in this population if we are serious about ending the epidemic.
 
 
 
 All Authors: No reported disclosures.
