Low PEP and PrEP awareness among trans people in London and their partners

Simon Collins, HIV i-Base

Results from a survey of trans people and their partners attending a sex-on-premises venue in central London showed low knowledge about both PEP and PrEP in people who were at high risk for HIV. [1]

This study was presented by Aedan Wolton from cliniQ, a sexual health and wellbeing clinic for trans people based at 56 Dean Street in Soho, London. [2]

This was part of a regular service that offered HIV testing and provided information about sexual health including awareness of PEP and PrEP. The venue caters for trans women, members of the cross-dressing/transvestite communities, and their mainly cis-gendered (i.e. not trans) male partners.

Results were presented from 131 responses over a 12-month period. Approximately two-thirds of participants identified as male (including 3% trans men and 17% who identified as cross-dressing or transvestite) and 30% female (nearly all trans women), with 1.5% non-binary.

Mean age was 46 (range 25 to 75). Ethnicity included 45% white UK, 10% white European, 8% south Asian with 12 other groups reported. Just over half (53%, n=70) reported condomless sex in the previous 6 months.

Overall, awareness of both PEP and PrEP was low.

Even though PEP has been available for more than a decade, less than one-third of respondents (31%, n=41) had heard of PEP, and only 24% (n=32) knew where to access it.

Awareness of PrEP was even lower, with only one in six respondents (16%, n=21) having heard of PrEP, and 14% (n=18) knowing how to get PrEP.

Even though trans communities have one of the highest rates of HIV, and even with information about PrEP from the health team at cliniQ, only 22% answered that they would be interested in using PrEP if it was available. Only 25 people gave reasons for reluctance to use PrEP, but 80% said this was due to worry about efficacy, 72% because of the cost and 44% because of concerns over drug interactions with hormone treatment.

Additionally, 133 HIV tests were provided, all of which, luckily, were HIV negative. HIV positive results have been reported by the service though, just outside the timeframe of the current analysis. Experience at cliniQ is that people either test HIV negative, or test HIV positive but with very advance late-stage infection. Continued outreach hopes to help with both more routine testing and earlier diagnosis.

In summary, the Trans:mission project showed low awareness of sexual health information in this population, despite high risk of HIV. The low awareness for both PEP and PrEP in trans communities and concerns about use led to the development of two new booklets by cliniQ, also available online. [3, 4]

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This project showed how to positively engage with trans communities so people can access appropriate health care.

This is especially important as the ongoing PrEP IMPACT study in England has ring-fenced allocations to enrol transgender people. [5]

Consistency and continuity of the service were both key to the success, enabling the same people to build up confidence to engage because the team continue to attend the same venue every month.

Reference

Wolton A et al. Trans:mission – a community-led HIV testing initiative for trans people and their partners at a central London sex-on-premises venue. 4th Joint BHIVA/BASHH Conference, 17–20 April 2018, Edinburgh. Oral abstract O29. Published in HIV Medicine, 19 (Suppl. 2), s5–s20. The webcast is 43 minutes into the session webcast.
http://www.bhiva.org/180419-Oral-Research-Presentations-Session-4.aspx (webcast)
cliniQ – Inclusive trans sexual health & wellbeing.
https://cliniq.org.uk
cliniQ. A trans woman’s guide to the sex club scene. (January 2018).
https://cliniq.org.uk/resources/the-hook-up-a-trans-womans-guide-to-the-sex-club-scene
cliniQ. A trans guy’s guide to the gay sex scene. (January 2018).
https://cliniq.org.uk/resources/cruising-a-trans-guys-guide-to-the-gay-sex-scene
PrEP IMPACT Trial.
https://www.prepimpacttrial.org.uk