Transgender and gender diverse (TGD) individuals represent a population with a heavy burden of HIV. Multi-level stigma encountered by TGD individuals can create significant barriers to discussing topics related to HIV prevention; however, research on communication between TGD patients and primary care providers (PCPs) about HIV vulnerability and prevention remains limited. This study used in-depth qualitative interviews with 25 TGD patients and 15 PCPs conducted in 2022 to explore perspectives on HIV vulnerability communication during primary care encounters. Overall, 14 of the TGD patients were nonbinary, genderqueer, or another gender identity; all but two participants identified as a sexual minority. The majority of PCPs (n = 11) were physicians. The range of years practicing medicine was between two and 39 years. Thematic analysis was used to organize codes and establish themes. Three broad themes regarding factors that facilitate communication regarding HIV vulnerability were identified: (1) focusing on behaviors over identities, (2) conveying impartiality, and (3) acknowledging individuality among TGD patients. Findings corroborate earlier research that identified strengths in providers refraining from behavior-based assumptions tied to a patient’s gender identity and sexual orientation and conveying impartial and nonjudgmental attitudes when discussing behaviors that can increase HIV vulnerability. Additionally, these findings underscore the significance of recognizing that, within the TGD community, all persons have unique circumstances, preferences, and needs. Future work should continue to explore the dynamics of HIV vulnerability and prevention discussions, especially among TGD individuals from diverse backgrounds and regions, to identify strategies for strengthening patient–provider communication and reducing vulnerability to HIV.

跨性别者和性别多元化 （TGD） 个体代表了 HIV 负担沉重的人群。TGD 个体遇到的多层次耻辱可能会对讨论与 HIV 预防相关的话题造成重大障碍;然而，关于 TGD 患者和初级保健提供者 （PCP） 之间关于 HIV 易感性和预防的沟通的研究仍然有限。本研究对 25 年进行的 15 名 TGD 患者和 2022 名 PCP 进行了深入的定性访谈，以探讨初级保健就诊期间 HIV 脆弱性沟通的观点。总体而言，14 名 TGD 患者是非二元性别、性别酷儿或其他性别认同;除两名参与者外，所有参与者都被认定为性少数群体。大多数 PCP （n = 11） 是医生。行医年限在 2 到 39 年之间。主题分析用于组织代码和建立主题。确定了关于促进 HIV 脆弱性沟通的因素的三大主题：（1） 关注行为而不是身份，（2） 传达公正性，以及 （3） 承认 TGD 患者的个体性。研究结果证实了早期的研究，该研究确定了提供者在讨论可能增加 HIV 脆弱性的行为时避免基于行为的假设以及传达公正和非评判态度的优势。此外，这些发现强调了认识到在 TGD 社区内，所有人都有独特的情况、偏好和需求的重要性。 未来的工作应继续探索 HIV 脆弱性和预防讨论的动态，尤其是在来自不同背景和地区的 TGD 个体之间，以确定加强患者与提供者沟通和降低 HIV 易感性的策略。