By Ethan Covey
Social determinants of health (SDOH) cause serious barriers to the access and uptake of HIV pre-exposure prophylaxis (PrEP) among transgender and nonbinary youth of color, according to a new study.
The study focused on sexual, racial and ethnic minorities in Bronx, N.Y., which has high rates of homelessness and unemployment. Additionally, previous research has shown that the estimated HIV prevalence among transgender people nationally is high, at 9.2%, and the risk for transgender women is even higher, at 14.1% (Curr Opin HIV AIDS 2014;9:168-173).
“A paucity of published data exists defining the risk of HIV in transgender or nonbinary youth of color,” said Michelle Collins-Ogle, MD, an assistant professor of pediatrics in the Division of Pediatric Infectious Diseases at the Children’s Hospital at Montefiore and the Albert Einstein College of Medicine, in Bronx, who also presented the findings at the 2022 IDWeek conference, in Washington, D.C.
During 2021 and 2022, Dr. Collins-Ogle and her colleagues conducted an assessment of 101 sexually active young people aged 14 to 27 years who identified as transgender and nonbinary to evaluate potential barriers to HIV prevention (poster 2091). Specifically, SDOH were examined by querying participants regarding the “four U’s”:
1. Unemployment
2. Uninsured/Underinsured status
3. Unstable housing
4. substance Use disorder
All patients were receiving gender-affirming care and PrEP or sexually transmitted infection (STI) testing at the Montefiore Adolescent and Youth Sexual-Health Clinic, in Bronx.
The researchers found that while gender-affirming care is associated with access and willingness for STI testing, SDOH caused significant barriers for these transgender and nonbinary young people.
Only 24% of transgender females initiated PrEP. Of those who did, 70% were adherent, while 20% seroconverted and 10% stopped taking PrEP.
When key SDOH were assessed, 23% reported unemployment, 11% unstable housing, 10% underinsurance and 40% substance abuse disorder. Roughly one-third of the young people enrolled reported a combination of the four U’s being barriers to initiating and maintaining PrEP.
Only three of the young participants who reported having more than one of the SDOH initiated PrEP. Despite awareness, initiation of PrEP and adherence among transgender females were disappointing, the researchers said.
“SDOH, specifically the four U’s, negatively impact [transgender and nonbinary] youth of color in the Bronx, and are prioritized over HIV prevention,” Dr. Collins-Ogle said. “Further studies are needed to understand the impact of an intervention that assesses their ability to understand risk and improve knowledge gaps within this age group to improve PrEP uptake in [transgender and nonbinary] youth of color.”
