Background: Transgender women (TGW) are known to be disproportionately affected by HIV. Although less is known about transgender men (TGM) recent studies have highlighted elevated risk in this population, especially among those who identify as MSM. PrEP is an effective biomedical intervention to prevent incident HIV infections, but adherence is reported to be lower among TGW. In 1/2014 Callen-Lorde Community Health Center, an LGBT-focused clinic in NYC that predominantly cares for HIV-infected and at-risk clients, implemented PrEP services. One of the goals was to create a program that was trans-inclusive.
Description: Almost 1500 clients have accessed PrEP since implementation of the program. Careful tracking of PrEP uptake revealed low involvement by transgender clients, with only 5 receiving PrEP in the first 6 months. Challenges included community-level lack of knowledge, provider and client under-estimation of HIV risk, especially among TGM, and lower rates of HIV-testing, resulting in fewer opportunities to discuss PrEP. The clinic responded by offering HIV screening during all new transgender intake appointments, distributing trans-inclusive education materials, PrEP education videos that included transgender/genderqueer actors. The clinic has intentionally become a more diverse work place with transgender counselors, testers, patient navigators and nurses.
Lessons learned: The interventions were successful. 118 transgender clients have accessed PrEP over 3 years, 8.4% of total prescriptions written. The majority 71.2% (84) have been TGW, 10.2% (12) genderqueer, and 18.6% (22) TGM. The populations differed by insurance and race with public “safety net” coverage being predominantly used by genderqueer and TGW (67% & 60.7%) whereas TGM predominantly used commercial insurance (64%). TGW were mostly nonwhite (70%) whereas TGM and genderqueer people were predominantly white (81% , 78%).
Conclusions/Next steps: As scale-up of PrEP continues, clinics considering implementation of PrEP need to ensure that they track utilization to monitor disparities among users. Addressing PrEP uptake among transgender clients requires a multi-faceted approach.

Uptake of PrEP by Transgender Clients at The Callen-Lorde Community Health Center
[Uptake of PrEP by Transgender Clients at The Callen-Lorde Community Health Center]