According to the Centers for Disease Control and Prevention, over 1.1 million people 13 years old and over are living with HIV, and nearly 14 percent of them are undiagnosed.
While studies from world health organizations continue to expand deeper realities unseen in the epidemic, transgender men are often excluded from the conversation — especially when it comes to PrEP, an HIV prevention strategy that when practiced routinely makes it impossible to contract HIV. Today, the only FDA-approved drug to be used as PrEP is Truvada, a once-daily pill.
Now, thanks to researchers at The Fenway Institute, a groundbreaking study is the first of its kind to investigate PrEP and other biological/psychological factors (like alcohol or substance abuse, depression, relationship status, needle sharing, and more) specifically among transgender men who have sex with men (MSM).
The study, which was published in the Journal of the International AIDS Society, was conducted online from November 2017 to December 2017 and included 857 trans MSM (aged between 18 to 60, though the majority of them were under 30), all of whom were surveyed by researchers to determine their PrEP use and HIV risk factors.
All participants had either receptive anal or vaginal sex with a cis male sex partner in the past six months, and all identified on the trans-masculine spectrum. More specifically, 71.6 percent identified as male/transgender man, 28.4 percent as nonbinary, and 32.6 percent as gay.
Overall, 84 percent of the participants acknowledged PrEP as an HIV prevention method, and 55 percent reported high-risk factors that indicate a greater need for them to be on PrEP. But, despite that number, only one-third of those in the study had ever taken PrEP.
Researchers suggest many reasons as to why PrEP use among trans men is low: mainly a lack of health insurance, poor access to HIV testing centers, or a lack of proper adherence. Furthermore, transgender men face unique social stigmas (as well as those who identify as nonbinary), which can make them exceptionally vulnerable to mental health issues and substance abuse.
While the CDC continues to make guidelines around PrEP that are mainly targeted for gay/bisexual men and transgender women, transgender MSM are largely overlooked. As a result, they’ve become a vulnerable community often ignored by medical providers who know very little about their needs and risks.
Findings show that transgender MSM will not only benefit from access to PrEP, but that HIV prevention research must make a stronger effort to include this population in future studies and trials so that we can better our public health interventions around the risk factors and vulnerabilities specific to trans men.
“Transgender MSM have been invisible in both transgender HIV prevention efforts and in cis MSM prevention delivery,” study co-author Dr. Sari Reisner, director of Transgender Health Research at The Fenway Institute and Assistant Professor of Pediatrics at Harvard Medical School, said in a statement. “Our study suggests that bio-behavioral HIV prevention methods, such as PrEP, should be made available to transgender MSM. Findings support the full inclusion of transgender MSM in biomedical HIV prevention services and research.”