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PrEP as an effective strategy in prevention of HIV in transgender women
Marta Villar. Work group on HIV treatments.
During the last AIDS International Conference (AIDS 2016) held in July in Duran (South Africa) several strategies were proposed to promote the use of Pre-exposure prophylaxis (PREP) among transgender people.
A meta-analysis of 39 studies carried out in 15 countries showed a global HIV prevalence of 19% in transgender women, with 49 times more chance of HIV infection than the observed in the general adult population. The highest prevalence – 22%– was seen in high resources countries, with transgender women of color being the most affected. (see La Noticia del Día 21/03/2016). There is little data available on transgender men.
Several studies that evaluated the use of PrEP in transgender women show that this tool is also efficient in HIV prevention. However, as observed in other studies, the effectiveness of this prophylaxis depends on maintaining a high level of adherence, something that was not seen in many transgender women in higher risk situation. (see La Notica del Día 10/12/2015).
About half of transgender people taking PrEP are under 30 years. Two thirds are transgender women (people who were assigned male at birth and that currently identify themselves as women); 16% are transgender men (people who were assigned female at birth and that currently identify themselves as men); and 17% are not happy with the gender division (most of them were assigned male at birth).
Some of the barriers that transgender people face when accessing PrEP include the lack of”trans-inclusive” information material on this preventive tool; the lack of reference on possible interactions between PrEP and hormonal therapy; and the distrust about the health community as a consequence of specific negative experiences with health professionals that are hostile and misinformed about the needs of transgender people.
According to Asa Radix, of the Callen-Lorde Community Health Center in New York (USA), it is crucial to create a welcoming and secure environment when providing care to transgender people. Callen-Lorde is the major specialized center that offers health services to lesbians, gays, bisexual and transgender people in New York. Currently around 15,000 visit the center, among which 3.095 are transgender men and women. More than half of the transgender users are of black or Latino ethnicity; one third of them do not have health insurance and 15% are homeless or have unstable housing.
Although availability and access to PrEP have significantly increased in the USA, this growth has been slow among transgender people. During the last 2 years, Callen-Lorde has grown from 1 or 2 transgender people that start the use of PrEP monthly to about 15. Currently, out of the 2.324 users receiving preventive treatment from the center, only 195 are transgender people.
Some policies that have been developed in the center to build a “trans-inclusive” environment and bring the use of PrEP to those patients, have created a registration form and online registry of patients, where they can state the sex assigned at birth, sex shown in their medical insurance documents and gender with which they identify themselves. They can also state the name they wish to be called.
Another measure taken by the center has been to hire transgender staff, include pictures of transgender people in the pamphlets promoting PrEP, in disclosure videos and on the clinic’s website.
The high prevalence of transgender people with HIV shows the need to promote virus prevention policies among this group of population. Although PrEP may be a good strategy to reduce the number of infections among transgender people, we should not forget the difficulties and obstacles faced by them day after day – such as poverty, lack of housing or high prevalence of sexual work – which must be taken into account when designing PrEP promotion programs aimed at this group.
Source: Aidsmap/ Prepared (gTt-VIH)
Reference: Radix A., Carneiro P., Mosher S., et al. Transgender patients at risk: ensuring access to PrEP in a NYC community health centre. 21st International AIDS Conference, Durban, abstract WEAC0202, 2016.
Carneiro P., Stephanos S., Mosher S., et al. What happens when PrEP is implemented? Experiences of a high volume community-based LGBT organization in New York City. 21st International AIDS Conference, Durban, abstract THPEE489, 2016.
Carneiro P., Radix A., Mosher S., et al. Implementing a successful PrEP program: lessons learned from the largest LGBT community health clinic in New York City. 21st International AIDS Conference, Durban, abstract THPEE444, 2016.