Sexual Well-Being Among Transgender and Non-Binary People Living in Canada.

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.