Abstract
IntroductionGlobally, transgender (“trans”) women are one of the key populations most disproportionately impacted by HIV. Pre-exposure prophylaxis (PrEP) is the newest and most promising biomedical HIV prevention intervention to date. This paper reviews relevant literature to describe the current state of the science and describes the potential role of PrEP among trans women, including a discussion of unique considerations for maximizing the impact of PrEP for this vulnerable population.MethodsAvailable information, including but not limited to existing scientific literature, about trans women and PrEP was reviewed and critiqued based on author expertise, including PrEP clinical trials and rollout.ResultsTo date, PrEP demonstration projects and clinical trials have largely excluded trans women, or have not included them in a meaningful way. Data collection strategies that fail to identify trans women in clinical trials and research further limit the ability to draw conclusions about trans women's unique needs and devise strategies to meet them. Gender-affirming providers and clinic environments are essential components of any sexual health programme that aims to serve trans women, as they will largely avoid settings that may result in stigmatizing encounters and threats to their identities. While there is currently no evidence to suggest drug-drug interactions between PrEP and commonly used feminizing hormone regimens, community concerns about potential interactions may limit interest in and uptake of PrEP among trans women.ConclusionsIn scaling up PrEP for trans women, it is essential to engage trans communities, utilize trans-inclusive research and marketing strategies and identify and/or train healthcare providers to provide gender-affirming healthcare to trans women, including transition-related care such as hormone provision. PrEP implementation guidelines must consider and address trans women's unique barriers and facilitators to uptake and adherence.
Highlights
Transgender (‘‘trans’’) women are one of the key populations most disproportionately impacted by HIV
Pre-exposure prophylaxis (PrEP) has garnered a great deal of interest and attention as the newest and most promising biomedical HIV prevention intervention developed and tested to date.The first clinical trial of PrEP included both high-risk men who have sex with men (MSM) and trans women; risk of HIV acquisition was reduced by 44% [22]
The future of PrEP among trans women relies on reversal of the relative invisibility of trans women in research and clinical services that inform the structure of programming and access to PrEP
Summary
Transgender (‘‘trans’’) women are disproportionately impacted by HIV worldwide [1]. A meta-analysis found that trans women are 49 times more likely to be living with HIV than the general population, with an estimated global pooled prevalence of 19% [2]. For the purposes of this discussion, the terms ‘‘transgender’’ or ‘‘trans’’ women describe people who share a common experience of being assigned male sex at birth, but who identify as female, transgender or trans female, or another identity along the trans-feminine spectrum, while acknowledging that cultural context introduces variability. At this time, there is limited information about the feasibility, acceptability and effectiveness of PrEP for trans women cross-culturally. Trans women who engage in sex work experience unique structural, interpersonal and individual vulnerabilities that contribute to a disproportionate risk for HIV compared with non-trans (or ‘‘cisgender,’’ a term often used to describe people who do not identify as transgender) male and female sex workers [16,17]. As this funding is recent, there are not yet any data available
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