Characteristics Associated with Pre-Exposure Prophylaxis Discussion and Use Among Transgender Women Without HIV Infection — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020

Abstract

CDC recommends pre-exposure prophylaxis (PrEP) for transgender women who have sex with men and who report sexual behaviors that place them at substantial ongoing risk for HIV exposure, including those who engage in nonsterile syringe sharing. Providing transgender women with access to PrEP is a critical strategy for reducing HIV acquisition and ending the HIV epidemic. Survey results from the National HIV Behavioral Surveillance Among Transgender Women were used to assess characteristics associated with past-year discussions of PrEP with a health care provider and PrEP use. Bivariate analyses were conducted to assess the association between covariates (sociodemographic, HIV-associated characteristics, and gender-affirming care) and each outcome, accounting for sampling design. All covariates that were statistically significant at p<0.05 in the bivariate analyses were included in multivariate models, and manual backward elimination was used to obtain final models that retained statistically significant covariates. Among 902 transgender women from seven urban areas in the United States without HIV infection in the analyses, 57% had recently discussed PrEP with a health care provider, and 32% recently had used PrEP. In the final multivariate model, the following subgroups of transgender women were more likely to report recent PrEP use: those who identified as Black or African American or Hispanic or Latina, had two or more sex partners in the past 12 months, had condomless sex in the past 12 months, reported their last sex partner was infected with HIV, had condomless sex with their last sex partner whose HIV status was positive or unknown, ever had transgender-specific health care, and currently had transgender-specific health insurance coverage. Participants who were less likely to have recently used PrEP were those who wanted to but were not currently taking hormones and those aged <40 years. Providing increased access to gender-affirming care and training health care providers who serve transgender women to incorporate PrEP into existing services might increase PrEP use among transgender women.

MMWR Supplement on National HIV Behavioral Surveillance Among Transgender Women—Seven Urban Areas, United States, 2019-2020

“…Transgender women are disparately affected by HIV: 42% of NHBS-Trans participants had confirmed HIV diagnoses, 4 yet only 32% of transgender women who were seronegative reported recently using any form of preexposure prophylaxis. 5 Repeated experiences of social marginalization and the constant struggle to meet basic needs exact a mental health toll that exacerbates the challenges experienced by transgender women in the United States. Among NHBS-Trans participants, 26% of transgender women had experienced psychological distress during the previous 30 days, 6 and 18% had seriously considered suicide during the previous 12 months.…”

“…Transgender women are disparately affected by HIV: 42% of NHBS-Trans participants had confirmed HIV diagnoses, 4 yet only 32% of transgender women who were seronegative reported recently using any form of preexposure prophylaxis. 5…”