Dynamics of Gender Identity With STI Diagnoses and Behavioral Outcomes Among Seattle Sexual Health Clinic Attendees, 2016-2023.

BACKGROUND

Nonbinary/genderqueer (NB/GQ) individuals represent a distinct population with unique sexual health care needs. We characterize trends in clinic attendance, sociodemographics, sexually transmitted infection (STI), and drug use among NB/GQ patients at an urban sexual health clinic (SHC).

METHODS

We analyzed Public Health, Seattle & King County, Seattle (PHSKC) SHC visit data collected between January 2016 and October 2023. We used the Cochran-Armitage trend test to identify trends in reported gender identity and χ 2 tests to identify sociodemographic characteristics associated with cisgender, transgender, and NB/GQ. We evaluated the associations between gender identity and the prevalence of syphilis, urogenital gonorrhea, rectal chlamydia infection, methamphetamine, and nonprescribed injection drug use using generalized estimating equations.

RESULTS

Of 82,384 visits, 1672 (2.0%), 867 (1.1%), and 79,845 (96.9%) were NB/GQ, transgender, and cisgender patients, respectively. From 2016 to 2023, the proportion of visits among NB/GQ and transgender patients increased from 0.7% to 3.5% and 0.7% to 1.7%, respectively ( p trend<0.001). NB/GQ identity was more common among patients assigned female versus male sex at birth (3.2% vs 1.8%, P < 0.001), younger vs older patients (14-25 years: 3.1% vs >46: 0.2%, P < 0.001), and white versus black patients (2.3% vs 1.0%, P < 0.001). Compared with MSM, NB/GQ patients had significantly lower odds of urogenital gonorrhea (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.32-0.80). The differences in rectal chlamydia (aOR, 0.78; 95% CI, 0.59-1.02) and syphilis (aOR, 0.96; 95% CI, 0.87-1.06) were not statistically significant. There were no significant differences between the NB/GQ and transgender visits.

CONCLUSIONS

Gender diversity among SHC attendees increased significantly over the 8 years. Continued monitoring is essential for tailoring STI/HIV prevention strategies.