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. 2025 Jul 7;24(1):197.
doi: 10.1186/s12939-025-02574-4.

Inequities in HIV prevention among trans and/or non-binary people: a cross-sectional survey analysis of PrEP and PEP awareness and use in Spain

Sara Moreno-García #  1 , Paule González-Recio #  2   3 , Marta Donat  4 , Carlos Iniesta  5   6 , Cinta Folch  3   6   7   8 , María Alonso-Colón  2   9 , Juan Miguel Guerras #  3   10 , María José Belza #  2   3
Affiliations

Inequities in HIV prevention among trans and/or non-binary people: a cross-sectional survey analysis of PrEP and PEP awareness and use in Spain

Sara Moreno-García et al. Int J Equity Health. .

Abstract

Background: HIV continues to be a global public health challenge, especially in transgender and non-binary people (TGNB). Despite the high effectiveness of Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) in reducing HIV transmission, their implementation in this population is unknown. This study describes PrEP and PEP awareness, knowledge of how to access, and use and identifies the factors associated among the TGNB population living in Spain.

Methods: Data from 1468 participants in Transaludes, a national online survey aimed at TGNB people living in Spain, were analysed. The prevalence of awareness, knowledge of how to access both PrEP and PEP through the public healthcare system, and use of each strategy were estimated. Factors associated with awareness and use were analysed using Poisson regressions with robust variance.

Results: A total of 50.5% were aware of PrEP, 14.7% knew how to access PrEP, 2.8% had used it and 1.6% currently, mostly on a daily regimen. A total of 32.5% were aware of PEP, only 13.2% knew how to access PEP and 1.6% had used it, mostly once. Awareness of both strategies was associated with being a non-binary person assigned male at birth (AMAB) or trans woman, being foreign, having a university degree, having undergone biomedical transition and in the past year, having condomless sex with one partner and having engaged in sex work. Use was associated with being older, living in large cities, and in the past year, having condomless sex with two or more partners, having engaged in sex work, and having an STI diagnosis.

Conclusions: Awareness of PrEP is moderate, while that of PEP is lower; in both cases, there is a high lack of knowledge about how to access them, and use of both strategies is low. Disparities, particularly among certain subgroups, such as trans men, younger TGNB, those with low educational level and those living in smaller cities, reflect structural inequities in access to both strategies. Targeted and tailored strategies, including campaigns to improve awareness and access to these prevention tools are needed to reduce these gaps within TGNB populations and achieve the goals for ending the HIV epidemic.

Keywords: HIV prevention; Post-exposure prophylaxis; Pre-exposure prophylaxis; Public health disparities; Transgender health.

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Conflict of interest statement

Declarations. Ethics: All people gave their informed consent voluntarily and did not receive any type of economic incentive. The questionnaire ensured anonymity and confidentiality by not collecting identifying data. The study was approved by the Research Ethics Committee of the Carlos III Health Institute (CEI PI 44_2023-v3). Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PrEP continuum indicators among the population of trans and/or non-binary people without HIV infection living in Spain (N = 1468)
Fig. 2
Fig. 2
Frequency of PEP lifetime use among trans and/or non-binary people without HIV infection living in Spain (N = 24)
See this image and copyright information in PMC

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References

    1. UNAIDS. 2020 Global AIDS Update ⁠— Seizing the moment ⁠— Tackling entrenched inequalities to end epidemics. 2020.
    1. UNAIDS. In Danger: UNAIDS Global AIDS Update 2022. 2022 [cited 2024 Sep 25]. Available from: https://www.unaids.org/en/resources/documents/2022/in-danger-global-aids...
    1. UNAIDS. HIV and transgender and other gender-diverse people — Human rights fact sheet series 2021. 2021. Available from: https://www.unaids.org/en/resources/documents/2021/04-hiv-human-rights-f...
    1. Falck F, Bränström R. The significance of structural stigma towards transgender people in health care encounters across Europe: Health care access, gender identity disclosure, and discrimination in health care as a function of national legislation and public attitudes. BMC Public Health. 2023 May 31 [cited 2024 Jan 26];23(1):1031. Available from: 10.1186/s12889-023-15856-9 - PMC - PubMed
    1. Stengaard AR, Combs L, Supervie V, Croxford S, Desai S, Sullivan AK et al. HIV seroprevalence in five key populations in Europe: a systematic literature review, 2009 to 2019. Eurosurveillance. 2021 Nov 25 [cited 2024 Sep 2];26(47):2100044. Available from: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.47.2100044 - PMC - PubMed

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