Transgender Women and Pre-Exposure Prophylaxis: What We Know and What We Still Need to Know

Transgender Women and Pre-Exposure Prophylaxis: What We Know and What We Still Need to Know

December 1, 2015
Author: Samantha Marquez and Sean Cahill
National Center for Innovation in HIV Care
PrEP and Transgender Women Cover

This brief includes:

  • A discussion of the research to date on the safety of PrEP use among transgender women
  • Guidance for clinicians on prescribing PrEP to transgender women
  • Recommendations for more intensive research on HIV prevention technologies for transgender women

Executive Summary: Transgender women are at elevated risk of becoming infected with HIV. Pre-exposure prophylaxis for HIV prevention (PrEP) is effective in reducing the risk of HIV infection among men who have sex with men (MSM), heterosexual men and women, and people who inject drugs (PWID). While transgender women have been included in some clinical trials of PrEP, no study has shown PrEP to be effective in reducing transgender women’s HIV risk. Low adherence is likely a major factor in this lack of demonstrated efficacy. Questions have also been raised about the interaction between feminizing hormones and the medication currently approved for use as PrEP for HIV prevention—emtricitabine and tenofovir disoproxil fumarate (FTC-TDF). More research is needed to demonstrate that PrEP is effective for preventing HIV infection among transgender women engaging in anal intercourse with men. Research is also needed to better understand the interaction of PrEP and feminizing hormones, and any potential impact on the ability of PrEP to build up in sufficient concentrations in rectal tissue. In the meantime, PrEP is a prevention option that transgender women should consider with their medical providers. PrEP could prevent HIV infection in transgender women as it has been shown to do in other populations.