Abstract
Safe and effective HIV prevention strategies are needed for transwomen. Transwomen in the US have a 34 times greater odds of being infected with HIV than all adults age 15-49, and in San Francisco, California 42.4% of transwomen are estimated to be infected with HIV. Pre-exposure prophylaxis (PrEP) is the first biomedical intervention with promise for reducing HIV acquisition in transwomen. However, little is known about whether transwomen know about PrEP, are taking PrEP and would be good candidates for PrEP based on their risk profile and behaviors. A population-based dataset was analyzed to determine how many transwomen in San Francisco knew about PrEP by the end of 2013 – more than a year after iPrex results demonstrated efficacy of PrEP in preventing HIV. We found that of 233 transwomen, only 13.7% had heard of PrEP. Transwomen who were living with HIV compared to those who were HIV-negative, and those who recently injected drugs compared to non-injection drug users were more likely to have heard of PrEP. Based on CDC guidelines for PrEP among MSM and IDU, 45 (30.2%) transwomen of the 149 HIV-negative transwomen in the sample were candidates for PrEP. This estimate based on CDC criteria is arguably low. Given that almost half of transwomen in San Francisco are living with HIV, this findings points to a need for further consideration of PrEP criteria that are specific and tailored to the risks for HIV faced by transwomen that are different from MSM and injection drug users. Research to scale up access and test the effectiveness of PrEP for transwomen is also urgently needed.
Highlights
Transgender women are part of a persistent HIV epidemic in the United States (US) for which few interventions have offered hope of delivering effective HIV prevention approaches [1]
Given that almost half of transwomen in San Francisco are living with HIV, this findings points to a need for further consideration of Pre-exposure prophylaxis (PrEP) criteria that are specific and tailored to the risks for HIV faced by transwomen that are different from MSM and injection drug users
32 transwomen, or just 13.7% had heard of PrEP, and only one person of those 32 who had heard of PrEP was willing to use PrEP for HIV prevention
Summary
Transgender women (transwomen) are part of a persistent HIV epidemic in the United States (US) for which few interventions have offered hope of delivering effective HIV prevention approaches [1]. Research for over a decade has demonstrated elevated HIV infection rates among transwomen; over a quarter in the US are HIV-positive [2,3,4]. Transwomen and PrEP general population of reproductive age adults in all countries with data [5]. This figure is high even compared to other key populations at risk for HIV such as men who have sex with men in the Americas with a 33.3-fold odds of HIV infection (18.7-fold in Asia, 3.8-fold in Africa, and 1.3-fold in Eastern Europe) and 13.5-fold for female sex workers (FSW) [6]. Data on the odds of HIV infection for transwomen are lacking, in part, because transgender people are not identified in National HIV surveillance data
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