by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer
August 13, 2024
Featured Literature:
Carneiro PB, Radix AE, Golub S, Grosskopf N, Grov C. PrEP use in a U.S. national sample of trans men and other trans masculine men who have sex with men: a longitudinal analysis. JAIDS. 2024. Online ahead of print: DOI: 10.1097/QAI.0000000000003492
This study aimed to provide information on PrEP uptake among transgender men and other transmusculine people who have sex with cisgender men (TMSM), by describing PrEP use and its predictors in a national sample. Data from a prospective, internet-based U.S. cohort of TMSM were analyzed to determine PrEP use, discontinuation, and other HIV prevention measures over a 24-month period. 196 eligible participants enrolled via geosocial networking apps during the first half of 2020 had complete data at baseline, 12-months, and 24-months. 94% were taking gender affirming hormones, 71% had undergone top surgery, and 34% had undergone some type of bottom surgery. 80% reported recent condomless anal or vaginal sex. 1% reported PrEP use in the prior 12 months, and 30% had a recent STI diagnosis. Multivariate analyses indicated that odds of PrEP use were higher for participants with health insurance (adjusted OR 4.87), recent post-exposure prophylaxis use (aOR 4.3), recent STI diagnosis (aOR 2.33), or bottom surgery (aOR 2.12). Overall, 58/196 (30%) started PrEP throughout the 24-month follow-up period, 22 continuously used PrEP (i.e., started at some point between baseline and 12-months, and continued through 24-months), and 1 participant discontinued more than once. 44 PrEP initiations were reported between baseline and 12-months, with 15/44 (34%) discontinuing by 12-months. 57 PrEP initiations were reported between 12- and 24-months, with 15/57 (26%) discontinuing by 24-months. Seven participants reported using FTC/TAF as PrEP and five reported using event-driven dosing.
Author’s Commentary:
This is one of the first published longitudinal analyses of PrEP use in a sample of transgender men and other transmasculine people who have sex with cisgender men. Authors note that people of trans experience may be less likely to be ready to consider engagement in HIV prevention until gender-affirming care priorities have been achieved. In this study population, the majority of which seemed to have access to gender affirming care (i.e., a high proportion were insured and reported having a primary care provider), low incident PrEP use and high rates of discontinuation were observed. Analyses identified structural and behavioral factors associated with PrEP uptake, as well as patterns of ‘alternative’ PrEP use among some participants – these point to important opportunities across policy, research, and clinical practice to better meet the needs of TMSM communities.
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