PrEP use in a U.S. national sample of trans men and other trans masculine men who have sex with men: a longitudinal analysis

Efforts to improve PrEP uptake among gay men, transgender women, and Black cisgender women are evident across the US, responding to epidemiologic data showing a disproportionate HIV burden in these communities. However, transgender men and other trans masculine people (TMSM)—those assigned female at birth who identify otherwise and have sex with cisgender men—are often excluded from these statistics. This community has unique vulnerabilities and prevention needs. National HIV prevention and planning have yet to include transgender men as a group with increased vulnerability to HIV seroconversion. This study follows a cohort of TMSM to characterize PrEP use longitudinally. Using data from a prospective U.S. national cohort of TMSM not on PrEP, we analyzed annual PrEP uptake, discontinuation, and other HIV prevention measures over 24 months. We also used generalized estimating equations (GEE) modeling to assess demographic, healthcare access, gender-affirming, and behavioral factors associated with PrEP uptake over time. Our cohort of 196 TMSM was demographic and regionally diverse. 29% of our sample reported uptake of PrEP in 24-months, with about one-third of users discontinuing within one-year. Health insurance, having had lower surgery, used PEP or recently having a STI were associated with increased odds of PrEP use. We found low uptake of PrEP and high discontinuation rates in a U.S. national sample of TMSM over 24 months, despite significant need for HIV prevention. It is vital to increase efforts and investments to support this neglected community.