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. 2025 Jul;26(5):798-813.
doi: 10.1007/s11121-025-01814-x. Epub 2025 Jun 6.

Gender-Affirming Care as a Predictor of HIV Pre-Exposure Prophylaxis Use and Adherence Among Young Trans Feminine Adults: A Coincidence Analysis

Alithia Zamantakis  1   2 , Richard Do  3   4 , Reiping Huang  3   4 , Artur A F L N Queiroz  5 , Brian Mustanski  6   7   8
Affiliations

Gender-Affirming Care as a Predictor of HIV Pre-Exposure Prophylaxis Use and Adherence Among Young Trans Feminine Adults: A Coincidence Analysis

Alithia Zamantakis et al. Prev Sci. 2025 Jul.

Abstract

We used coincidence analysis to explore whether various forms of gender-affirming care (GAC) in the presence or absence of medical mistrust facilitate HIV pre-exposure prophylaxis (PrEP) use and adherence. Using secondary data collected between 2014 and 2024 from the RADAR Cohort Study, we performed two crisp-set coincidence analyses with 86 trans feminine young adults for PrEP use and 24 trans feminine young adults for PrEP adherence. Our final model for PrEP use explained over 90% of participants who had used PrEP in the past 6 months with 60% consistency. This model identified receipt of hormone replacement therapy (HRT) OR being on parental insurance as predictors of PrEP use. We identified two final models for PrEP adherence, which explained 50% of participants with 83% consistency: (1) past receipt of puberty blockers OR high suspicion of medical providers in the absence of parental insurance; (2) current or past receipt of HRT in the absence of barriers to GAC and the absence of parental insurance. Our study highlights the significant role of GAC in facilitating PrEP use and adherence among trans feminine individuals. Specifically, HRT and the absence of parental insurance emerged as key predictors, underscoring the need for integrated and accessible GAC to enhance PrEP uptake and adherence in this population.

Keywords: Gender-affirming surgery; HIV; Hormone replacement therapy; Pre-exposure prophylaxis; Puberty blockers; Transfeminine persons.

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Conflict of interest statement

Declarations. Ethics Approval and Informed Consent: This analysis was approved by the Northwestern University IRB as non-human subjects research and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. All RADAR study participants provided their consent for their data to be used in additional research, including secondary data analyses. Conflict of interest: The authors declare that they have no conflict of interest. Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Third Coast Center for AIDS Research.

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