HIV & Trans Communities
While there is limited data about HIV rates among trans people, enough data exists to understand that some trans people do experience a higher risk of HIV infection than the general population. This is especially so for trans people who have receptive anal or vaginal/frontal sex with someone who has a penis…
who they are not in a monogamous relationship with;
who has an unknown HIV status or is HIV+ and is not on treatment; and
·without the use HIV prevention tools like condoms.
Trans people might also be at an increased risk of HIV infection if they share injection drug equipment or if their identities overlap with other populations which are disproportionately impacted by HIV, such as indigenous people or people who identify as African, Caribbean, or Black.
HIV Risk & The Gender Binary
Information about HIV “risk” is often gendered. This can make it challenging for trans, non-binary, and other people who may not identify within the gender binary to accurately determine their HIV risk and which prevention options they might consider.
For example, it is often said that trans women and trans men who “have sex with men” are at a higher risk of HIV. However, what is often meant by this is that a person having receptive anal or receptive vaginal/frontal sex with someone who has a penis is at an increased risk of HIV infection. However, we know that some women have penises and some men do not.
Relying only on gendered language to discuss risk can result in people over-or-underestimating their true HIV risk and result in them not taking necessary precautions or taking precautions which aren’t necessary. Therefore, whenever possible, healthcare and service providers should use gender neutral language which focuses on body parts and how they’re used during sex, as these are often more accurate determinants of risk than broad generalizations about gender alone.
PrEP & Trans Communities
There are a few points that trans and non-binary people and the healthcare and service providers supporting them should consider concerning PrEP use. These include:
HRT: PrEP is safe to take while on hormone replacement therapy (HRT).
PrEP & Gender-Affirming Surgeries: There is limited evidence to understand how PrEP works in bodies that have undergone gender-affirming surgeries.
Differing PrEP Concentration Levels: It is important to note that PrEP can take longer to reach maximum concentration in vaginal/frontal tissues than it does to reach maximum concentration in rectal tissues. This has important impacts for trans people who have vaginas/front holes.
For example, “on-demand PrEP” is considered effective for “men who have sex with men.” However, there are concerns that taking PrEP this way would not allow sufficient concentration of PrEP to build up in vaginal/frontal tissues to offer effective protection against HIV. Therefore, while “on-demand PrEP” might be an effective way of taking PrEP for cisgender men, it is not recommended for most trans men.
Gender-Affirming PrEP Care
Access to trans-inclusive healthcare can be a challenge for many trans people. Accessing care within a setting that is not inclusive can lead to experiences of stigma and discrimination, which can have a negative impact on healthcare access and medication adherence. This includes PrEP access.
Healthcare and service providers should help trans and non-binary people to find PrEP prescribers and healthcare settings that provide gender-affirming, inclusive care. This includes providers and settings that respect names and pronouns, allow patients to use the bathroom of their choice, and whose staff are culturally competent.