The association of gender-affirming care with PrEP use among transgender women in Seattle

Transgender women are inequitably burdened with HIV worldwide. Pre-exposure prophylaxis (PrEP) issafe and effective at preventing HIV acquisition, but uptake is low. Integrating HIV care and gender- affirming care may increase PrEP uptake. We conducted a cross-sectional study using the Seattle 2023- 2024 National HIV Behavioral Surveillance (NHBS-Trans) survey (N = 149). A composite score for gender-affirming care (low, intermediate, high) was used to estimate prevalence and examine associations with PrEP use. Only 30% of participants used PrEP in the prior 12 months; among them, 60% reported high adherence. Fifty-eight percent had high access to gender-affirming care, 29% intermediate, and 13% low. Chi-square and Fisher’s exact tests showed those with high access had a proportion of PrEP use over three times that of those with low access (PR: 3.31, 95% CI: 0.87-12.7); intermediate access nearly three times that of those with low access (PR: 2.87, 95% CI: 0.72-11.5). Multivariate log binomial regression showed similar patterns for high (PRadj: 3.37, 95% CI: 0.5-25) and intermediate access (PRadj: 3.65, 95% CI: 0.5, 25). Though not statistically significant, these results support integration of PrEP with gender-affirming care as a holistic strategy to improve uptake among transgender women.