Transgender and nonbinary people who receive gender-affirming hormone therapy may be less likely to acquire HIV and more likely to achieve viral suppression if they do, according to a recent study. In recent years, researchers have made progress in understanding outcomes among trans people living with or at risk for HIV, but political shifts could put further advances in jeopardy.

 

Sari Reisner, ScD, of the University of Michigan School of Public Health, and colleagues looked at outcomes among gender-diverse people receiving primary care at Callen-Lorde Community Health Center in New York City and Fenway Health in Boston. More than a third were transgender women, about 30% were trans men and the proportion of nonbinary people more than doubled over time.

 

As the proportion of trans people receiving gender-affirming hormone therapy increased, HIV prevalence and the likelihood of having un-controlled virus declined. In 2013, 86% of the 2,983 participants were prescribed hormone therapy, and 9% were HIV positive; of these, 22% did not have viral suppression. By 2019, there were 8,109 participants, and the proportion on hormone therapy had risen to 89%. A smaller proportion were HIV positive (7%); of these, 16% did not have viral suppression. The overall HIV prevalence in this study was lower than rates previously reported for trans people, but Black and Latina transgender women were much more likely to be HIV positive than the cohort as a whole.

 

The researchers calculated that receiving hormone therapy was associated with a 37% lower rate of HIV seropositivity and a 44% lower likelihood of having uncontrolled virus. “Gender-affirming care is important for optimizing HIV outcomes among trans people,” they concluded. “Combination interventions that pair gender-affirming hormone therapy with other services, such as PrEP for HIV prevention and HIV care, might hold promise.”