Sin How Lim

In this session, presentations focused on the potential impact on oral PrEP on feminizing hormone therapy (FHT) among transgender women (TGW), and assessment of optimal/suboptimal hormone levels among transgender men and women from a community-based clinic that offers gender-affirming care, and preferences for long-acting injectable (LAI) PrEP among TGW.

In a PrEP demonstration study in Brazil, Dr Cattani explored the potential impact of daily oral PrEP on FHT among Brazilian transwomen. The good news is that oral PrEP did not impact the efficacy of FHT. There were no drug-drug interactions. Dr Hiransuthikul and his team assessed the hormone levels among TGW and transgender men from the Tangerine Clinic in Thailand. Tangerine clinic offers transgender-led, integrated, gender-affirming care to transgender communities in Bangkok. At baseline, one third of transgender women who were using FHT had any hormones within target level and 13% of transgender men who were using male hormone therapy had optimal testosterone levels. At 12-months follow up visits, proportion with optimal hormone levels for both transgender groups increased. In a cross-sectional study, TGW clients from the Tangerine clinic were asked about their preferences for Long Acting Injectable (LAI) PrEP. Around three-quarters of Thai TGW who were currently using oral PrEP as well as those who discontinued PrEP preferred LAI PrEP. Specifically, those who perceived PrEP as beneficial and were recently diagnosed with sexually transmitted infections (STIs) preferred LAI PrEP. The Q&A session highlighted the need for more research on transgender men and their unmet needs in HIV prevention.

This session adds to the evidence base that oral PrEP does not negatively affect the efficacy of FHT among TGW. Hence, both can be used concomitantly. The integration of supervised Gender-Affirming Hormone Therapy in HIV care has improved hormone levels to optimal levels, emphasizing its positive effects in transgender-competent healthcare facilities. The integrated HIV care model that provides gender-affirming care is needed to improve HIV care among transgender men and women. Future studies should focus on transgender men and the use of new innovations such as LAI PrEP among transgender people, especially regarding drug interactions with sex hormones.