HIV and Trans Women: A Literature Review

Transgend Health. 2018; 3(1): 239–250

Abstract:

Trans women are a key, yet under-researched, population in the HIV epidemic. However, there remains a paucity of data on the health and wellbeing of trans women at risk of, or living with, HIV in the United Kingdom.

This article provides a narrative review of key empirical research into HIV among trans women. In an effort to explore individual and social factors in relation to HIV in this population, we outline key tenets of identity process theory from social psychology and the concept of structural violence from medical anthropology.

We focus on published studies around the following themes: (1) epidemiological data, (2) syndemic factors (3) barriers to social support, (4) HIV and gender transitioning, and (5) access to and engagement with health care.

We identify lacunae and thus call for United Kingdom-based research in the following areas: (1) the prevalence and incidence of HIV in trans women, (2) the impact of syndemic factors on HIV risk and acquisition in trans women, (3) the nature of social support for coping with syndemic factors, (4) the interface of gender transitioning and HIV, and (5) barriers to accessing HIV prevention and care services.

There is great scope (and urgency) for research into HIV among trans women, especially in the United Kingdom, to reduce incidence in this group, to enhance engagement in HIV care across the care continuum, and to improve the health and wellbeing of those living with HIV. A tentative model for HIV prevention and care is presented in this article.

Transgender women taking PrEP have lower levels of PrEP drugs than cisgender men

aidsmap/nam, November 9th 2018

A study presented at October’s HIV Research for Prevention conference (HIVR4P) in Madrid shows that transgender women who are taking feminising hormones and also taking pre-exposure prophylaxis (PrEP) have levels of the PrEP drugs tenofovir and emtricitabine in their blood that are about 25% lower than those in cisgender men, and levels in rectal tissue cells about 40% lower. Tenofovir levels in rectal tissue were 44% lower.

However, the study also confirmed that the interaction between hormones and PrEP did not appear to go the other way; blood levels of estradiol, the one hormone all of the transgender women took in one form or another, do not appear to be affected by PrEP.

 

The updated 2017 ASHM HIV pre-exposure prophylaxis (PrEP) Guidelines

Journal of Virus Eradication, 2017; 3: 168–184

Daily use of co-formulated tenofovir and emtricitabine for HIV pre-exposure prophylaxis (PrEP) by populations at high risk of HIV infection is now recommended in guidelines from the United States, Europe and Australia and globally through the 2015 WHO guidelines. 

These 2017 Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine‘s (ASHM) PrEP Guidelines are an updated adaptation of the 2014 US Centers for Disease Control‘s PrEP guidelines and are designed to:

    • Support the prescription of PrEP using forms of coformulated tenofovir and emtricitabine that have been registered in Australia by the Therapeutic Goods Administration and other bioequivalent generic drugs that are available in Australia through self-importation, private prescription or Australian PrEP clinical trials
    • Assist clinicians in the evaluation of patients who are seeking PrEP
    • Assist clinicians in commencing and monitoring patients on PrEP including PrEP dosing schedules, management of side-effects and toxicity, use of PrEP in pregnancy and in chronic hepatitis B infection and how to cease PrEP

Daily PrEP with co-formulated tenofovir and emtricitabine, used continuously or for shorter periods of time, is recommended in these guidelines as a key HIV-prevention option for men who have sex with men (MSM), transgender men and women, heterosexual men and women, and people who inject drugs (PWID) at substantial risk of HIV acquisition.

Australian report finds disturbing evidence of gender inequality

Guardian Australia, March 8th

Incorrect assumptions are being made that gender equality has been achieved despite disturbing and comprehensive evidence to the contrary, an investigation by Australia’s sex discrimination commissioner, Kate Jenkins, has found.

“There are many different voices in this, and my voice is tied to having spoken to rural women, LGBTI women, older women, women with disabilities, migrant women and Aboriginal women.”

  • Read more of article here 
  • Download the report (PDF) here
  • Download the infographic (jpg) here

 

STI rates in PrEP users very high, but evidence that PrEP increases them is inconclusive

nam/aidsmap, Published: 22 February 2017
A study of PrEP users presented last week showed that PrEP users had very high rates of STI diagnosis – in the order of 20 times higher than among HIV-negative gay men in the general population. The evidence that STIs increased further while people were on PrEP was, however, a lot more ambiguous.
The problem in proving that PrEP has any causal relationship to STIs is that STIs among gay men were, in general, rising before well before PrEP, and also that PrEP usually involves regular testing for HIV and STIs. Since many STIs are asymptomatic and self-limiting, more tests will result in more diagnoses.
Read more here 

Evidence that “on-demand” PrEP taken before and after sex can prevent HIV

How many doses of Truvada-based PrEP (pre-exposure prophylaxis) are needed to provide adequate protection against HIV? Might it be possible to take PrEP only before and after sex—instead of every day?

A recent article published in The Lancet HIV provides insight into this very question.

  • Read more here
  • Access Lancet HIV abstract here (for full text please see your librarian)