Pre-exposure prophylaxis (PrEP), a two-drug antiretroviral used to prevent HIV, can be effective in transgender women when used consistently, according to research published in The Lancet HIV.

Researchers at the University of California, San Francisco (UCSF), led by Robert M. Grant, MD, professor of medicine, and colleagues, re-examined preexisting data from the iPrEx trial, conducted between 2007 and 2011. The study enrolled 2,500 HIV-negative gay and bisexual men and transgender women in Peru, Ecuador, Brazil, Thailand, South Africa, and the United States. Initial reports identified 29 transgender women; the new analysis identified 339 transgender women.

“We looked at blood levels of the drug in a sub-group of participants. We found no drug in the transgender women who became infected. And, no transgender woman participant with drug levels equal to four or more doses a week became infected with HIV…. We did find strong evidence pointing to efficacy.”

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The iPrEx trial was the first to show the efficacy of a single daily pill of oral antiretroviral medication consisting of emtricitabane and tenofovir disoproxil fumarate for use in HIV-negative gay and bisexual men. The FDA and CDC recommend PrEP for use in gay and bisexual men and heterosexual men and women at risk for acquiring HIV. The CDC recommendations do not mention transgender women, and no evidence-based HIV prevention interventions geared specifically toward transgender women exist.

A 2008 analysis found that more than a quarter of transgender women in the United States are HIV positive, and a larger-scale 2013 analysis found that a fifth of transgender women across 15 participating countries are HIV positive, showing that, worldwide, transgender women are at a high risk of HIV infection.

“When transgender women take PrEP as prescribed, it appears to work, but to retain and encourage PrEP use, research should be conducted and interventions should be delivered in gender-affirming environments,” said study co-author JoAnne Keatley, MSW, director of the UCSF Center of Excellence for Transgender Health. “PrEP delivery programs should … be explicitly designed to support transgender women.”


Deutsch MB, Glidden DV, Sevelius J, et al. HIV pre-exposure prophylaxis in transgender women: a subgroup analysis of the iPrEx trial. Lancet HIV. 2015; doi: 10.1016/S2352-3018(15)00206-4.