ABSTRACT
Background. 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 nonbinary (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. Methods. 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. Results. 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. Conclusion. 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.