Delivering HIV Prevention and Care to Transgender People: An Update

Worldwide, according to UNAIDS, individuals identifying as transgender remain among the most heavily affected by HIV and are considered a key population. Within this group, transgender women are the most vulnerable. In 2018, the risk of contracting HIV was 12 times higher for transgender women than for adults aged 15 to 49. Risk factors for HIV infection include engaging in condomless sex, lower perceived risk of HIV, multiple sex partners, and sharing equipment to inject hormones or drugs. Stigma may be the largest barrier to access to care for HIV+ transgender people. Transgender people face discrimination from both their HIV status and gender identity/expression, but also are more likely to be involved in the underground economy (sex work, illegal drug dealing), which presents unique challenges in risk management. This population is also more likely to have mood and anxiety disorders, substance use and trauma. Taking a trauma informed approach to treat this population will be key to rapport building, good therapy outcomes, as well as to identify root causes of what is often seen as problematic patient behavior. Pre-Exposure Prophylaxis with tenofovir/emtricitabine is a valuable HIV prevention tool in this population with increased risk for HIV infection. Overall knowledge of risk for HIV infection, stigma and its effect on health outcomes, as well as the use PrEP when taking care of patients identifying as transgender is a necessary step in reducing the incidence of new HIV infections. Dr. Casasnovas will start this session by reviewing the epidemiologic data and risk of HIV infection in individuals identifying as transgender, including individual perceived risk and its effect on health outcomes Using the stigma-sickness slope theory, Dr. Lichtenstein will explore issues of stigma, access to care, and discrimination. He will discuss how compounding layers of stigma adversely affect health outcomes and increase morbidity and mortality. Dr. Ashley will review the indications for the use of PrEP and its role in HIV prevention in the transgender community, including potential barriers. Finally, Dr. Pereira will discuss recent data pertaining possible risk compensation behavior in PrEP users, uptake, and future pharmacological preventive methods.