title: The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices.
abstract: Globally, transgender ("trans") women are one of the key populations most disproportionately impacted by HIV. Pre-exposure prophylaxis (PrEP) is the newest and most promising biomedical HIV prevention intervention to date. This paper reviews relevant literature to describe the current state of the science and describes the potential role of PrEP among trans women, including a discussion of unique considerations for maximizing the impact of PrEP for this vulnerable population.
  
  
  
  Available information, including but not limited to existing scientific literature, about trans women and PrEP was reviewed and critiqued based on author expertise, including PrEP clinical trials and rollout.
  
  
  
  To date, PrEP demonstration projects and clinical trials have largely excluded trans women, or have not included them in a meaningful way. Data collection strategies that fail to identify trans women in clinical trials and research further limit the ability to draw conclusions about trans women's unique needs and devise strategies to meet them. Gender-affirming providers and clinic environments are essential components of any sexual health programme that aims to serve trans women, as they will largely avoid settings that may result in stigmatizing encounters and threats to their identities. While there is currently no evidence to suggest drug-drug interactions between PrEP and commonly used feminizing hormone regimens, community concerns about potential interactions may limit interest in and uptake of PrEP among trans women.
  
  
  
  In scaling up PrEP for trans women, it is essential to engage trans communities, utilize trans-inclusive research and marketing strategies and identify and/or train healthcare providers to provide gender-affirming healthcare to trans women, including transition-related care such as hormone provision. PrEP implementation guidelines must consider and address trans women's unique barriers and facilitators to uptake and adherence.
authors.affiliation: Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, USA.|Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Jae.Sevelius@ucsf.edu.
authors.forename: Jae M
authors.initials: JM
authors.lastname: Sevelius
authors.affiliation: Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, USA.|Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Madeline B
authors.initials: MB
authors.lastname: Deutsch
authors.affiliation: Gladstone Institute, University of California, San Francisco, San Francisco, CA, USA.|San Francisco AIDS Foundation, San Francisco, CA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Grant
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D065129:Pre-Exposure Prophylaxis; D060728:Reproductive Health; D012725:Sexual Behavior; D013240:Stereotyping; D063106:Transgender Persons / Q000523:psychology; D035862:Vulnerable Populations
chemical_list: D019380:Anti-HIV Agents
keywords: HIV prevention; PrEP; transgender women