Identifying Barriers to PrEP Uptake, Adherence for Transgender Patients

Concerns about interactions with gender-affirming hormone therapy are a large barrier to the use of pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) in transgender populations in the United States, according to a study published in AIDS Patient Care and STDS.

“HIV PrEP is highly effective at preventing HIV; however, PrEP use among transgender individuals remains low,” wrote corresponding author Steven A John, PhD, MPH, of the Medical College of Wisconsin’s Center for AIDS Intervention Research, and coauthors.

To identify barriers, as well as facilitators, to PrEP use among US residents who are transgender, researchers conducted a systematic review of 33 studies. All studies provided specific results for transgender participants.

In addition to significant concerns about PrEP interactions with hormone therapy, the review identified several other common themes in the population.

Distrust in medical institutions affects PrEP uptake, researchers reported, and social networks also carry weighty influence on a person’s PrEP knowledge, interest, and adherence. Nevertheless, initiating PrEP may increase self-advocacy and self-acceptance among people who are transgender, studies suggest.

The review also found lower PrEP concentrations among people taking feminizing hormones, but the difference did not seem clinically significant.

“Training health care providers to provide inclusive and affirming care is perhaps one of the strongest areas for intervention to increase PrEP uptake and persistence,” researchers advised.

Reference:
Dang M, Scheim AI, Teti M, et al. Barriers and facilitators to HIV pre-exposure prophylaxis uptake, adherence, and persistence among transgender populations in the United States: a systematic review. AIDS Patient Care STDS. 2022;36(6):236-248. doi:10.1089/apc.2021.0236