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Transgender Women and PrEP

Transgender women are at elevated risk of becoming infected with HIV. Pre-exposure prophylaxis for HIV prevention (PrEP) is effective in reducing the risk of HIV infection among men who have sex with men (MSM), heterosexual men and women, and people who inject drugs (PWID). Transgender women have been included in some clinical trials of PrEP, but only as a small minority of participants in studies with non-transgender MSM. Until an analysis of transgender data from two research studies was published in November 2015, no study had shown PrEP to be effective in reducing transgender women’s HIV risk. Low adherence is likely a major factor in this general lack of demonstrated efficacy. However, the analysis of the transgender samples of two PrEP clinical research trials published in The Lancet in November 2015 demonstrated some efficacy among transgender women who were adherent to PrEP.

Questions have been raised about the interaction between feminizing hormones and the medication currently approved for use as PrEP for HIV prevention—emtricitabine and tenofovir disoproxil fumarate (FTC-TDF). More research is needed to demonstrate that PrEP is effective for preventing HIV infection among transgender women engaging in anal intercourse with men. Research is also needed to better understand the interaction of PrEP and feminizing hormones, and any potential impact on the ability of PrEP to build up in su cient concentrations in rectal tissue. In the meantime, PrEP is a prevention option that transgender women should consider with their medical providers. PrEP could prevent HIV infection in transgender women. 

This resource was produced by the National Center for Innovation in HIV Care, a partnership between The Fenway InstituteAIDS Resource Center of Wisconsin, and AIDS United.

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