“My Identity is up for Inspection”: A Qualitative Exploration of Intersectional Stigma as a Barrier to Sexually Transmitted Infection Prevention, Testing, and Care Among Transgender and Gender Diverse Adults

Abstract Introduction Transgender (trans) and gender diverse (TGD) people are disproportionately affected by sexually transmitted infections (STIs), including those other than Human Immunodeficiency Virus (HIV), driven in part by anti-trans stigma and intersecting systems of oppression that disrupt access to sexual healthcare. This study aimed to highlight the intersectional barriers TGD adults encounter when accessing sexual healthcare. Methods In 2022, 10 semi-structured focus groups were conducted with a sample of thirty-six TGD adults, including nonbinary individuals ( n = 26, 72.0%), trans men ( n = 7, 19.4%), and trans women ( n = 3, 8.3%). Just over one-quarter of participants ( n = 10, 28.0%) identified as people of color. Data were analyzed using reflexive thematic analysis to generate themes related to intersectional stigma and TGD adults’ sexual healthcare experiences. Results Two themes were created from the data: (1) Beyond anti-trans stigma: The overlooked systems that adversely shape STI testing and care among TGD people; and (2) “I have to test the waters on all of those things”: How interlocking oppression compounds barriers to care. Structural stigmas manifested at multiple levels, underscoring how intersecting oppression created and reinforced barriers to sexual healthcare access. Conclusions The study highlights how intersecting systems of oppression shape barriers to affirming sexual healthcare among TGD adults. Findings signaled the importance of training healthcare providers and changing institutional policies and practices to foster affirming healthcare environments and address barriers to STI prevention, testing, and care, thereby promoting sexual health equity. Policy Implications Findings support the need for intersectional, structural-level change, including state- or municipal-level legal protections and accessible insurance coverage policies. At the institutional level, revising health informatics, provider training curricula, and intake forms can help create trans-inclusive spaces and further ensure access to affirming testing and sexual healthcare experiences.