Similar Sexual Behaviour yet Different Outcomes: Comparing Trans and Gender Diverse and Cis PrEP Users in Germany Based on the Outcomes of the PrApp Study

Max Nicolai Appenroth,Stefan Albrecht,Ulrich Marcus,Viviane Bremer,Uwe Koppe,Klaus Jansen,Barbara Gunsenheimer-Bartmeyer

doi:10.3390/sexes3010014

Max Nicolai Appenroth, Stefan Albrecht + Show 5 more

Open Access

https://doi.org/10.3390/sexes3010014

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Abstract

Little knowledge about pre-exposure prophylaxis (PrEP) use in trans and gender diverse (TGD) communities in Germany exists. The PrApp Study collected data on PrEP use and sexual behaviour among PrEP users in Germany. Descriptive methods and logistic regression were used to describe PrEP use among TGD and cis persons. A total of 4350 PrEP users in Germany were included, with 65 (1.5%) identified as TGD. Compared to cis participants, TGD participants were younger (median age 29 vs. 37 years) and more likely to have a lower income (adjusted odds ratio (aOR) = 4.4; 95% confidence interval (CI) = 2.4–8.2) and be born outside Germany (aOR = 2.5; 95% CI = 1.3–4.5). On-demand PrEP use was higher in TGD participants (aOR = 1.9; 95% CI = 1.0–3.5) and numerically more TGD obtained PrEP from informal sources (aOR = 1.8; 95% CI = 0.9–3.5). Testing behaviour, condom use, and number of sexual partners were comparable between both groups. Socioeconomic disparities may constitute structural barriers for TGD people to access PrEP, leading to more informal and on-demand use. PrEP providers need to reduce access barriers for TGD PrEP users and provide information on safe PrEP use for this population.

Highlights

Recruitment of current and former pre-exposure prophylaxis (PrEP) users was done via local community human immunodeficiency virus (HIV) and sexually transmitted infection (STI) testing clinics, three dating apps used by men who have sex with men (MSM), and a community-run website [28]
We included a total of 4350 current PrEP users from Germany
Being a Trans and gender diverse (TGD) participant was associated with a lower gross annual income (Table 1): 56.9% of participating TGD individuals had an income of EUR 30,000 or less per year, compared to 22.6% of cis participants

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Trans and gender diverse (TGD; see Abbreviations) people do not identify with their sex assigned at birth. TGD people can identify as male/masculine (i.e., trans men) or female/feminine (i.e., trans women). At times, they oppose the normative gender labels of male and female and identify outside of the gender binary or do not solely identify as male or female (i.e., non-binary, gender non-conforming, agender, etc.; see ‘Abbreviations’)

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Discussion

Conclusion