Meeting gender-affirming needs tied to accessing HIV services among transgender people

Having met gender-affirming care needs among transgender people is associated with accessing HIV-related services in a community-led clinic, as shown in a Philippines study presented at IAS 2023.

“Integrating gender-affirming care and HIV-related services provides an opportunity to address multiple health issues of transgender people holistically,” according to the researchers, led by Patrick Eustaquio from LoveYourself, Research and Innovations, Mandaluyong City, Philippines.

Eustaquio and his team conducted a cross sectional study to describe the characteristics and health-seeking intentions of transgender people enrolled in Victoria by LoveYourself, a community clinic in Metro Manila, from March 2017 to December 2019.

The researchers stratified the participants based on whether they initially accessed sexual health (ie, HIV and/or HIV testing, treatment, or prevention) or gender-affirming care services (ie, gender-affirming surgery/procedure assessment or hormonal therapy). Using Chi-square or Fisher exact tests, they calculated the differences in proportions.

A total of 530 transgender people enrolled in the clinic, of whom 64.0 percent were transgender men, 35.1 were transgender women, and 0.9 percent were nonbinary. [IAS 2023, abstract 558]

Most of the participants (82.5 percent) went to LoveYourself to meet their gender-affirming needs even though 47.9 percent were already on gender-affirming hormonal therapy and 30.0 percent had undergone at least one gender-affirming surgery. Additionally, 73 transgender people (13.8 percent) had initially accessed sexual health services, most of which (91.8 percent) were HIV-related consultations.

Notably, the proportion of participants who initially enrolled for sexual health services were higher among transgender women and nonbinary people (p<0.001), men who have sex with men (p<0.001), those who have undergone gender-affirming surgery (p=0.047), and those already on gender-affirming hormonal therapy (p=0.001).

“There is limited uptake of HIV services among transgender people. Concurrently, gender-affirming care is inaccessible, such that some self-administer hormones or receive surgeries from unregulated providers. Both issues perpetuate health disparities on HIV and wellbeing,” the researchers said.

PrEP awareness

These findings are in line with those of another study involving transgender women in 11 countries in Asia, including Cambodia, China, India, Indonesia, Lao PDR, Malaysia, Myanmar, Nepal, Philippines, Thailand, and Vietnam.

Specifically, 77.6 percent of 1,250 transgender women reported being aware of HIV pre-exposure prophylaxis (PrEP), although 20.8 percent admitted to having not used it despite wanting to. The top reasons for this were concerns about side effects (42.6 percent), did not know where/how to get PrEP (34.2 percent), and unavailability of PrEP (27.7 percent). [IAS 2023, abstract 3457]

Among PrEP users, 78.1 percent were still using it, but 19.5 percent had stopped due to the following reasons: not having too much sex (30.4 percent), not wanting to take pills (27.8 percent), and concerns about side effects (26.1 percent).

In addition, 2.4 percent of participants discontinued PrEP use permanently because of the following: monogamous relationship (35.7 percent), unavailability of PrEP (35.7 percent), and concerns about side effects (28.6 percent).

“Implementation strategies to facilitate PrEP availability and access to PrEP service tailored to transgender women are urgently needed,” according to the investigators, led by Rena Janamnuaysook from the Institute of HIV Research and Innovation, Bangkok, Thailand.

Janamnuaysook and colleagues analysed cascade data on PrEP awareness, use, and continuation among transgender women respondents from an online cross-sectional survey conducted in 11 countries in Asia between May and November 2022. They used multivariable logistic regression to identify factors associated with PrEP awareness.