On the heels of World AIDS Day, a study on the effectiveness of Truvada PrEP in reducing and preventing HIV transmission has been further analyzed to show that it works not only for men, but for trans women as well.
The study was conducted between 2007 and 2009 on approximately 2,500 participants from Brazil, Ecuador, Peru, South Africa, Thailand, and the United States. Each participant took either Truvada PrEP (pre-exposure prophylaxis, an antiretroviral drug that prevents HIV transmission) or a placebo pill daily. The large majority of the participants were gay or bisexual men, but just over 300 are broadly considered trans women. Specifically, “339 (14%) [participants] were classified as transgender women, including 29 (1%) who identified as women, 296 (12%) who identified as trans or ‘travesti,’ and 14 (1%) who identified as men but reported use of feminising hormones.”
Because the study was focused on men who have sex with men (MSM) and not specifically trans women, the analysis is not perfect, but a number of interesting conclusions could be made. As compared to the MSM who participated in the study, trans women were half as likely to take the PrEP pill daily, even when they were at higher risk for transmission, as measured by a variety of risk factors, including frequency of condom-less anal sex. However, among those who took the pill at least 4 times per week, not a single one became infected with HIV.
The general conclusion among trials of Truvada PrEP has been that it is enormously effective in preventing HIV transmission among MSM, and it is heartening to see such success with trans women as well. There remains, however, concern about low usage by this subset of the high-risk population. Madeline Deutsch, one of those involved in the subgroup analysis of the study, said of the results: “[O]ne factor leading to lower rates of pill-taking may be due to either a fear of, or lack of information about drug-drug interactions between PrEP and gender-affirming hormone medications. For transgender women, their gender-affirming medications are a higher priority.”
While it may be oversimplifying to claim that all trans women prioritize gender-affirming medications like hormone replacement therapy over HIV prevention medications, a lack of information about the drug-drug interactions is certainly a problem. Furthermore, the barriers to access faced by trans women are tremendous, and for Truvada PrEP to be useful, it must be made available to them. Finally, no studies on the effectiveness of PrEP have been conducted yet with trans women in mind, only as an afterthought. In order to really understand and help prevent HIV transmission among trans women, the medical community must acknowledge and work to address their specific needs.
Regardless of your current level of sexual activity, I encourage you all to make an appointment to get tested for HIV. Home tests are available but can provide false negatives, and so I recommend you seek out your local Planned Parenthood, doctor’s office, or other sexual health clinic.