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HIV PrEP Referrals Lag for Black MSM, Trans Adults

State health departments were most likely to refer heterosexual adults for HIV preexposure prophylaxis (PrEP) appointments and least likely to refer transgender and Black adults, according to the results of a 12-city PrEP demonstration project.

The project, Project PrIDE, was meant to close the PrEP gap between White and cisgender adults and their Black, Latinx, Native American, and transgender peers.

“Black people appear to be less likely to be engaged in PrEP services than other racial and ethnic groups,” Jarvis said at the virtual United States Conference on HIV/AIDS (USCHA) 2020. “We also saw this trend among Black MSM [men who have sex with men], as they had lower PrEP uptake than other racial/ethnic MSM groups.”

The federal free PrEP program Ending the HIV Epidemic: Ready, Set, PrEP on October 29. Inasmuch as obtaining PrEPs requires a prescription, bridging this referral gap will be key to achieving that goal in the United States.

“The disparities in HIV incidence and health outcomes among transgender persons reflect profound inequities, ones that are present and don’t need to be,” said Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. He was speaking at USCHA’s closing plenary. “We are working to ensure that HIV does not become a part of these other life stresses.”

Demonstrating Transgender Inclusion

Project PrIDE was funded by the CDC in 12 locales, including New York City, Baltimore, San Francisco, Louisiana, Michigan, Colorado, and Tennessee. Its goal was to collect more data on and increase access to PrEP in underserved populations of MSM and transgender adults, particularly communities of color.

It makes sense. After all, young Black MSM make up a small part of the population but accounted for 26% of new HIV diagnoses in 2018, according to the CDC. Data suggest that transgender adults, particularly Black women of transgender experience, have inequitably high rates of HIV. One study suggested that 14% of transgender women have HIV, and that’s the figure that Mermin used at USCHA.

But early studies of PrEP included few transgender people. Transgender adults have expressed concern over the fact that the medications used for PrEP were not initially tested in large enough numbers of transgender women and that tenofovir disoproxil fumarate, one of the drugs in the HIV prevention pill Truvada (Gilead Sciences), could reduce the effectiveness of feminizing hormones for transgender women. That turned out not to be true, as evidenced by results of early studies. Although Black Americans make up about half of those who could most benefit from PrEP, they account for only 1% of PrEP users. Since 2012, when the FDA approved Truvada for PrEP, activists have been pushing for more projects that make PrEP available to transgender people and people of color.