Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Epidemiology and Biostatistics

Supervisor

Bauer, Greta R.

Abstract

This dissertation aimed to: (1) assess the prevalence and predictors of HIV testing, pre-exposure prophylaxis (PrEP) awareness, and PrEP uptake; 2) evaluate the validity of the Trans-Specific Condom/Barrier Negotiation Self-Efficacy measure (T-Barrier); and (3) explore latent profiles of trans-specific sexual well-being, their correlates, and their impacts on thriving. The data source for this research was the 2019 Trans PULSE Canada survey, a national, convenience sampling, comprehensive health survey of transgender (trans) and non-binary people living in Canada. The results pertaining to Objective 1 identified a need to improve access to PrEP and HIV testing in this population. Although most participants were aware of PrEP, few reported current or previous PrEP use. Additionally, two-thirds of participants who had engaged in condomless vaginal or anal sex in the past year had not been tested for HIV in the same period. Encouragingly, individuals with greater HIV-related sexual risk indication were more likely to have been aware of PrEP, to have used PrEP, and to have been tested for HIV in the past year. Multivariable regression analyses revealed multiple sociodemographic inequities in PrEP awareness and identified emotional social support as a facilitator of PrEP awareness. For Objective 2, confirmatory factor analysis supported the validity, reliability, and measurement invariance across gender groups of T-Barrier among sexually active trans and non-binary individuals in Canada. In addressing Objective 3, latent profile analysis identified four latent sexual well-being profiles among sexually active transmasculine and transfeminine individuals: a higher, a lower, and two moderate sexual well-being profiles in each gender group. Bivariable analyses identified significant associations between sexual well-being profiles and participant characteristics. Multivariable analyses found that profiles with higher sexual well-being were associated with higher levels of thriving. These findings highlight the need for holistic, population-specific approaches to supporting sexual well-being among trans and non-binary people in Canada.

Summary for Lay Audience

Sexual well-being is an important part of overall health that affects quality of life. Transgender (trans) and non-binary populations face unique challenges related to sexual well-being, including discrimination and gender-related distress. While much research among trans populations has focused on the medical aspects of sexual well-being, such as gender-affirming medical care, there is a need for a broader understanding of the non-medical aspects of sexual well-being. To address this need, this dissertation explored aspects of sexual well-being beyond those related to medical care in a large national survey of trans and non-binary people in Canada. First, we assessed access to HIV prevention services. We found a need to improve the levels of HIV testing and awareness and use of pre-exposure prophylaxis (PrEP), a highly effective medication that HIV-negative individuals can take to reduce their risk of HIV infection. However, those at higher sexual risk of HIV infection were also more likely to be aware of PrEP and to have been tested for HIV in the past year. We identified subgroups of trans and non-binary people in Canada that were less likely to be aware of PrEP and we found that emotional social support played an important role in PrEP awareness. In a separate analysis, we provided data supporting the validity of a trans-specific measure of confidence in negotiating condom/barrier use with partners. This analysis supported the use of this tool in assessing safer sexual practices in this population. Finally, in our last study, we identified four distinct profiles of trans-specific sexual well-being based on participants’ responses to nine measures of dimensions of sexual well-being (e.g., sexual satisfaction, gender distress). This sample for this analysis was participants who had ever been sexually active with a partner. These profiles highlighted the wide range of sexual well-being experiences among trans and non-binary people in Canada. Further, we found that participants belonging to profiles with greater levels of sexual well-being tended to report better overall psychological well-being. Overall, the findings of this dissertation highlight the importance of holistic, trans-specific approaches to sexual well-being research, education, promotion, and care among trans and non-binary populations.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.

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Available for download on Friday, April 23, 2027

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