Trans men & PrEP: Providing affirming care despite lack of data

Here’s what we know about the relationship between trans men and HIV: not a lot.

Only a fraction of the HIV research on LGBTQ+ communities examines data on trans individuals as a demographic group. And only a fraction of that fraction specifically dives into the experiences of trans men.

“There is an unbelievable lack of knowledge here in 2024,” said Rae Onders, HIV prevention coordinator for Neighborhood Family Practice (NFP), a network of community health centers on Cleveland’s West Side. “All we can do is provide the best and most affirming approach to everyone who walks through the door.”

In the world of HIV prevention and care, NFP’s approach includes HIV testing, comprehensive care for those living with HIV and highlighting the availability of the HIV-prevention medication Pre-Exposure Prophylaxis (PrEP).

Despite PrEP reducing the risk of getting HIV from sex by about 99% when taken as prescribed, there is still much work to be done to highlight the availability of the medication in healthcare settings.

Brittani Flory, HIV Prevention nurse for NFP, notes that there are many providers in the field who still don’t know about PrEP, including providers who unnecessarily send individuals to infectious disease specialists if they inquire about the medication. Although NFP has seen a sharp uptick in prescriptions for PrEP over the past few years – almost triple! – inquiries and knowledge about the drug are far from universal.

“From a healthcare perspective, we’re doing a lot better than we were, but we have a long way to go,” Flory said.

Addressing the barriers

The lack of knowledge on PrEP, combined with the lack of research on trans men and HIV, comes together to paint a picture that is significantly less than rosy. According to one research study, trans men experience great difficulties in accessing HIV care due to various factors, including higher rates of poverty, lack of access to transportation and negative encounters within the healthcare system.

It is that last factor that NFP aims to comprehensively address.

“The entire experience of a healthcare visit has to be welcoming, from the greeting you receive when you enter the door, to seeing people who look like you on the printed materials in the waiting room, to the actual visit with the provider,” said Onders.

NFP sees the creation of a welcoming atmosphere as a constant process, rather than a fixed end goal.

“We just recently completed training with the LGBT Community Center of Greater Cleveland to make sure we’re using the best possible language in working with the communities we serve,” Onders said. “We’re committed to that goal.”

Improving awareness and access

Additional concerns with trans men and PrEP are centered on how the HIV-prevention medication interacts with hormones the client might be taking. NFP stands at the ready to combat misinformation.

“Guidelines and data indicate that, yes, PrEP is safe to take with hormones,” Flory said.

Access to PrEP is a final concern, particularly with recent court cases that have had implications for insurance coverage. In the 2023 Braidwood Management v. Becerra case, a judge ruled that Chrsitian business owners could deny PrEP coverage in their insurance policies if it violates their religious beliefs.

Here too, NFP wants to help clients navigate the process.

“There are so many options out there to cover PrEP, including Medicaid and Prevention Assistance Program Interventions (PAPI),” Onders said. “Our goal is to work with everyone individually to get access to PrEP, no matter their circumstance.”

There are two PrEP regimens approved for trans men and nonbinary people assigned female at birth:

Daily oral medication
Injections every two months

Both methods are available at NFP, in addition to full sexually transmitted infection (STI) testing, extragenital testing, behavioral and mental health services. But first, clients need to start the process of actually making an appointment, which means overcoming barriers between trans men and healthcare providers.

“Trans people have medical mistrust and rightfully so,” Flory said. “Rather than ignore that, we need to transform it, which means doing the work to make sure each and every client feels supported.” 🔥

IGNITE ACTION

Read all about the NFP’s HIV & Prevention Care/Services by visiting their site here. On the site, you can schedule an appointment for a health screening and learn more about services including testing and PrEP.