A new study from the Williams Institute at UCLA School of Law finds that only 3% of transgender adults in the U.S. who are at high risk for HIV infection use pre-exposure prophylaxis (PrEP). High risk for HIV transmission was defined in the study as those not living with HIV who had had sex with cisgender men and/or transgender women within 5 years.

The Centers for Disease Control and Prevention (CDC) regards PrEP as a highly effective tool to prevent the transmission of HIV. Previous research has shown that transgender people, and particularly transgender women, are disproportionately impacted by HIV.

The current study found that 23% of transgender people who are at high risk for HIV infection have never been tested for HIV, while 46% are tested for HIV annually, as recommended by the CDC. Transgender people of color and those who searched online for LGBT health resources were more likely than other transgender people to be tested regularly as recommended by the CDC.

Slightly less than half (48%) of sexually active transgender people are familiar with PrEP, and 72% of them have a favorable attitude toward it. More sexually active trans men (58%) than trans women (35%) were familiar with PrEP.

“That awareness of PrEP was so low among sexually active trans women is concerning given the high rates of HIV among trans women,” said the study’s principal investigator Ilan H. Meyer, Ph.D., Distinguished Senior Scholar of Public Policy at the Williams Institute. “It is also troubling that a significant percentage of sexually active transgender people are not being tested or taking advantage of advancements that prevent the spread of HIV."

“People who experienced affirmation of their gender identity were more likely to use

PrEP than those who didn’t experience gender identity affirmation. This suggests that gender affirmation is an important factor in promoting HIV prevention and treatment for transgender people,” said Jae Sevelius, Ph.D., Associate Professor of Medicine at UC San Francisco. “Our findings reinforce the need for gender-affirming PrEP services for transgender people at risk of HIV.”

KEY FINDINGS

PrEP

• Only 3% of transgender people who are at high risk of HIV infection currently take PrEP; slightly more trans women (3.2%) than trans men (2.3%) take PrEP, but the difference was not statistically significant.
• People who regularly tested for HIV and people who experienced affirmation of their gender identity were more likely to use PrEP.
• Significantly more sexually active trans men (58%) than trans women (35%) were familiar with PrEP.
• Among trans people familiar with PrEP, 72% regarded it favorably.
• Those who were not tested for HIV at least once a year were less likely to have favorable attitudes toward PrEP.

HIV Testing

• Nearly half (46%) of transgender people who are at high risk of HIV transmission were tested for HIV at least annually, but 23% had never been tested for HIV.
• Transgender people of color were 8 times more likely than white transgender people to be tested at least once per year.
• People who searched online for LGBT health information were more likely to meet CDC recommendations for annual HIV testing.