Characteristics Associated With the HIV Preexposure Prophylaxis Care Continuum Among Transfeminine Persons in the United States

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BACKGROUND: Transfeminine persons are disproportionately burdened by risk of HIV acquisition. We examined the association between various characteristics with preexposure prophylaxis (PrEP) care continuum among a nationwide sample of transfeminine individuals in the United States. METHODS: Sexually active transfeminine persons age 15+ were recruited online between June 2022 and October 2023. We used Poisson regression models to examine factors associated with having a PrEP discussion with a health care provider and PrEP use among participants at risk for HIV. RESULTS: Overall, 12% (350/3007) of participants used daily oral PrEP and 26% (783/3007) reported a PrEP discussion with a provider in the past 12 months. Among participants who used PrEP in past 12 months, 79% (265/335) were currently using PrEP. Among participants who discussed PrEP with a provider, 43% (335/783) used PrEP in the past 12 months. In multivariable modeling, participants who had a sexually transmitted infection (STI) diagnosis, had more than 1 partner, used illicit drugs, used a prescribed medication via injection, and used hormones for gender affirmation in the past 12 months were more likely to have discussed PrEP. PrEP use in the past 12 months was higher among Black participants and among those who reported having multiple/other types of health insurance, having an STI diagnosis, having more than 1 partner, exchanging sex, and using a prescribed medication via injection. CONCLUSIONS: Increased engagement with health care system leads to higher likelihood of PrEP initiation among transfeminine persons. Reducing health care-related stigma can improve PrEP uptake and enhance HIV prevention among transfeminine persons.