Opinion: Transgender People and PrEP: The more we know, the more we don’t

This is what we know: There is big push from the biomedical community on the use of pre-exposure prophylaxis (PrEP) to prevent HIV acquisition.

While data shows that gay and bisexual men had very high levels of protection from HIV infection through intermittent pre-exposure prophylaxis (PrEP) timed around sexual activity, a mathematical model predicts that most women would require a daily oral dose of tenofovir/emtricitabine combo to prevent HIV infection from vaginal sex.

This data on the efficacy of oral PrEP is undeniably encouraging; however, more questions arise regarding the efficacy and dosing requirement for heterosexual and bisexual trans women as well as gay and bisexual trans men.

As we know the trans community is diverse. From our identities to our physiologies, trans women and men at different stages of gender transition are likely to have very different questions from gay and bisexual men and heterosexual and bisexual women.

The current studies, while claiming that they are inclusive of trans women and men, seem to lack the necessary nuances to make these data relevant to trans people who have sex with men.

In the coming years, the World Health Organization is planning to release consolidated guidelines that include the use of PrEP for all populations.

Until we can truly embrace and understand the difference between trans-responsive and trans-inclusive treatment and prevention, the biomedical community is likely to face more sceptics than followers when their prevention messages continue to miss the mark.

Cecilia S

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