Nonprescription Hormone Use Among Transgender Women — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020

Methods

Data Source

This report includes survey data from NHBS-Trans conducted by CDC during June 2019–February 2020 to assess behavioral risk factors, PrEP, antiretroviral therapy, condom use, and HIV prevalence. Eligible participants completed an interviewer-administered questionnaire and were offered HIV testing. Additional information about NHBS-Trans eligibility criteria, data collection, and biologic testing is available in the overview and methodology report of this supplement (11). The NHBS-Trans protocol questionnaire and documentation are available at https://www.cdc.gov/hiv/statistics/systems/nhbs/methods-questionnaires.html#trans.

Applicable local institutional review boards in each participating project area approved NHBS-Trans activities. The final NHBS-Trans sample included 1,608 transgender women in seven urban areas in the United States (Atlanta, Georgia; Los Angeles, California; New Orleans, Louisiana; New York, New York; Philadelphia, Pennsylvania; San Francisco, California; and Seattle, Washington) recruited by using respondent-driven sampling (RDS) This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.*

Participants were included in this analysis if they reported current or recent (during the past 12 months) hormone use and provided responses to questions about age, poverty, network size, insurance coverage, and access to transgender-specific health care (n = 1,165). The analysis excluded participants who did not use hormones during the past 12 months (the recall period for nonprescription hormone use and other NHBS-Trans measures) to avoid conflating participants with insurmountable barriers to hormone use and those not using hormones for other reasons.

Measures

Assessed demographic characteristics included age group (18–29, 30–39, 40–49, and ≥50 years) and education (less than high school, high school, some college or technical degree, and college degree or more). Other characteristics assessed included transgender-specific health insurance coverage, transgender-specific health care (as measured by ever having a health care provider with whom they felt comfortable discussing gender-related health issues), current hormone use, hormone use during the past 12 months, visiting a health care provider during the past 12 months, current or recent homelessness, recent sex work, and use of nonprescription hormones during the past 12 months (Table 1).

Analysis

Log-linked Poisson regression with generalized estimating equations were used to examine the association between nonprescription hormone use and social and structural factors related to health care access. Bivariate Poisson regression was performed to identify factors associated with recent use of nonprescription hormones. Respondent-driven sampling methodology and network effects were accounted for by clustering on recruitment chain, urban area, and self-reported network size; results are reported as adjusted prevalence ratios with 95% CIs. Variables significant (p<0.05) in bivariate analyses were carried forward to a multivariate model, and variables that remained significant (p<0.05) in multivariate analysis were included in the final model. Analyses were performed using SAS software (version 9.4; SAS Institute).