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Structural equation modeling was used to test mediation pathways between gender identity and PrEP uptake among the full sample and stratified by sex assigned at birth. Lifetime PrEP uptake was higher among those assigned male at birth (26%) versus assigned female at birth (9%), explained by greater structural and behavioral risks and perceived need for PrEP, especially among trans women. Among those assigned female at birth, PrEP uptake was higher among trans men (12%) than nonbinary participants (6%). Our findings characterize key structural and behavioral drivers of PrEP use and highlight the need to reduce barriers to healthcare for trans youth, particularly in the South.<\/jats:p>","DOI":"10.1007\/s10461-024-04590-x","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T03:59:45Z","timestamp":1738295985000},"page":"1136-1157","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["PrEP Disparities Among Transgender Feminine, Transgender Masculine, Nonbinary, and Gender Expansive Youth and Young Adults in the United States"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0880-2660","authenticated-orcid":false,"given":"Anne E.","family":"Fehrenbacher","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9360-9928","authenticated-orcid":false,"given":"Demetria","family":"Cain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5093-5862","authenticated-orcid":false,"given":"Joshua A.","family":"Rusow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swetha","family":"Lakshmanan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dianna","family":"Polanco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Demi","family":"Ward","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yara","family":"Tapia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0289-2842","authenticated-orcid":false,"given":"Risa P.","family":"Flynn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7728-0587","authenticated-orcid":false,"given":"Patrick S.","family":"Sullivan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1340-6371","authenticated-orcid":false,"given":"W. 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This research involved human participants. All participants provided voluntary informed consent to participate in the CARES or TechStep studies. This research was approved by the Institutional Review Boards of University of California Los Angeles, the IRB of record for all participating institutions in the CARES study, and the University of North Carolina at Chapel Hill, the IRB of record for all participating institutions in the TechStep study. This research was conducted in accordance with the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}