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. 2019 Sep;22(9):e25391.
doi: 10.1002/jia2.25391.

High risk and low uptake of pre-exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States

Sari L Reisner  1   2   3 , Chiara S Moore  1 , Andrew Asquith  1 , Dana J Pardee  1 , Aaron Sarvet  3 , Gal Mayer  4 , Kenneth H Mayer  1   5   6
Affiliations

High risk and low uptake of pre-exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States

Sari L Reisner et al. J Int AIDS Soc. 2019 Sep.

Abstract

Introduction: Trans masculine people who have sex with cisgender ("cis") men ("trans MSM") may be at-risk for HIV infection when they have cis MSM partners or share needles for hormone or recreational drug injection. Limited data are available characterizing indications and uptake of pre-exposure prophylaxis (PrEP) in trans MSM. The aim of this study was to assess PrEP indication and uptake as a means of primary HIV prevention for adult trans MSM in the U.S.

Methods: Between November and December 2017, a national convenience sample of trans MSM in the U.S. (n = 857) was recruited using participatory methodologies and completed an online survey of demographics, HIV risk, PrEP, behavioural and psychosocial factors. Self-reported receptive anal sex or frontal/vaginal sex (with or without a condom) with a cis male sex partner in past six months was an eligibility criterion. A multivariable logistic regression procedure was used to model PrEP indications (yes/no) per an interpretation of U.S. Centers of Disease Control and Prevention recommendations among those without HIV (n = 843).

Results: The diverse sample was 4.9% Black; 22.1% Latinx ethnicity; 28.4% non-binary gender identity; 32.6% gay-identified; 82.7% on testosterone. Overall, 84.1% had heard of PrEP. Of these, 33.3% reported lifetime PrEP use (21.8% current and 11.5% past). Based on HIV behavioural risk profiles in the last six months, 55.2% of respondents had indications for PrEP. In a multivariable model, factors associated with PrEP indication included where met sex partners, not having sex exclusively with cismen, higher perceived HIV risk, greater number of partners and high cis male partner stigma (all p < 0.05).

Discussion: The majority of trans MSM in this sample had a PrEP indication. Stigma was associated with risk for HIV acquisition and represents a critical target for HIV biobehavioural prevention interventions for trans MSM, who appear to be underutilizing PrEP.

Conclusions: Results from this study support the full inclusion of trans MSM in HIV biobehavioural prevention efforts. Public health interventions and programmes are needed to reach trans MSM that attend to general MSM risk factors as well as to vulnerabilities specific to trans MSM, including the context of stigma from cis male sexual partners.

Keywords: HIV; PrEP; men who have sex with men (MSM), sexual and gender minorities; social stigma; transgender persons.

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Figures

Figure 1
Figure 1. PrEP Indication by CDC MSM Criteria
PrEP, pre‐exposure prophylaxis; CDC, Centers for Disease Control and Prevention; MSM, men who have sex with men.
Figure 2
Figure 2. PrEP Indication by CDC Heterosexual Criteria
PrEP, pre‐exposure prophylaxis; CDC, Centers for Disease Control and Prevention
Figure 3
Figure 3. PrEP Indication by CDC IDU Criteria
PrEP, pre‐exposure prophylaxis; CDC, Centers for Disease Control and Prevention
Figure 4
Figure 4. PrEP Indication by Any CDC Criteria
PrEP, pre‐exposure prophylaxis; CDC, Centers for Disease Control and Prevention
See this image and copyright information in PMC

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