Access to PrEP is something we have been talking about a lot at Apicha CHC. Because we serve so many transgender and gender queer people, we are especially concerned with making sure they have access to PrEP. We are so proud to have a flourishing Transgender Health Clinic, which is currently serving over 600 transgender and gender queer people in NYC.
First, what is PrEP?
“PrEP” is short for Pre-Exposure Prophylaxis. It is a new HIV prevention method for people who are HIV-negative to use in order to decrease the risk of becoming infected if they are exposed to the HIV virus. PrEP has been approved by the FDA and is shown to be safe and effective.
Fast Facts We Need to Know
• Worldwide, 19.1% of transgender women are living with HIV.
• In the US, 21.6% of transgender women are living with HIV.
• The National Transgender Discrimination Survey reported that transgender people of color report exponentially higher rates of HIV – the highest rates were 24.9% for transgender African Americans (compared to 2.4% for all African Americans), 10.9% for transgender Latinos (compared to .08 for all Latino/as), as compared to a rate of 0.6% for the general US population.
• Few studies have been done on HIV prevalence among transgender men and gender non-conforming people, but there is reason to believe that these communities are more vulnerable to HIV than the general population. Click here to read more about this issue.
• HIV is more than three times more prevalent among black trans women than among white or Latina trans women.
• 19% of trans people surveyed have been refused medical care because of their gender identity; 28% have been harassed in a doctor’s office.
• Transgender people were also much more likely to be HIV-positive if they had been sexually assaulted because of their gender identity, did not have a high school diploma, had incomes below $10,000/year, or if they were unemployed or had lost a job due to bias.
Being Transgender or Gender Queer and Being on PrEP
Since PrEP became widely acknowledged and accepted as a means for HIV prevention, it has mostly been marketed as a prevention method for cis men who have sex with cis men. Transgender and gender queer people have been almost entirely left out of the conversation, the research and the marketing.
There has been a lot of resources and money dedicated to making pre-exposure prophylaxis accessible to the public, but very little of this has been dedicated to better understanding PrEP for transgender people.
In April, 2016 the California HIV/AIDS Research Program funded a PrEP research initiative focusing solely on HIV negative transgender and gender queer people. This is the first PrEP study to exclusively focus on the transgender community. We are anticipating the findings of this in-depth study, so that we can better understand the experiences of transgender people taking PrEP.
We are especially hopeful that this study will give us more insight into the way PrEP affects transgender men and gender queer people.
Taking PrEPBeginning The Process:
Taking the first step to preventing HIV is often the most difficult. The challenges of talking about your sexual practices with your doctor are very difficult to overcome. This is especially true for transgender and gender queer people, who encounter some of the most challenging barriers when it comes to accessing safe, comprehensive and respectful health services.
Affordability & Insurance:
Truvada for PrEP is covered by all New York State Medicaid plans as well as most private insurers. If you don’t have Medicaid or your insurance does not cover Truvada for PrEP, Gilead (the pharmaceutical company that makes Truvada) has a Medication Assistance Program that can provide the medication free of charge to eligible patients.
If you are uninsured or underinsured, NYS has a PrEP Assistance Program, PrEP-AP, which can pay for PrEP related visits and lab cost for eligible patients, regardless of immigration status.
PrEP and Hormone Therapy:
From the research done on hormone therapy and the most commonly prescribed HIV meds, including Truvada (PrEP), there appears to be little to no interaction. If you have concerns about this, we encourage you to speak with your medical provider.
Side Effects of PrEP:
The main side effects are mild nausea and problems with kidney function. Kidney problems are reversible; stopping Truvada makes the kidneys return to normal. Everyone who takes PrEP should see their medical provider for kidney function tests every six months.
Although PrEP protects you from HIV, it does not protect users from other sexually transmitted infections. So, protecting yourself against STDs is a key component of your sexual health.
Your Body on PrEP:
Pre-Exposure Prophylaxis involves taking the medication, Truvada, once a day, every day. When taken correctly and every day, PrEP is 92%-99% effective in reducing your risk of getting HIV. When taken daily, PrEP takes at least 7 days to reach maximum protection for rectal tissue, and 20 days in blood or for vaginal tissues.
What is Apicha Doing
If you are an HIV negative transgender or gender queer patient at Apicha CHC, our Transgender Health Clinic Coordinators (THCC) will talk to you about getting on PrEP.
Rather than have your use of PrEP be supported by the center’s PrEP navigators, yours will be managed by your THCC. This is important because they have the appropriate experience to provide the best PrEP care for transgender and gender queer patients with their understanding of the unique barriers transgender people face.
Between 2015 and 2016 at Apicha CHC, 12.6% of our patients on PrEP identified as transgender or gender queer. Of our transgender and genderqueer patients on PrEP, 88% are female-identified, 7% male-identified and 5% gender queer.
At Apicha CHC, we are very aware of the short-comings in research and access. We are very grateful to have the support of the AIDS Institute and the New York City Department of Health to support our PrEP program and encourage outreach to underserved communities.
If You’re Trans*, Live in New York City, and Don’t Have a Medical Provider, Consider Coming to Apicha CHC!
Check our calendar for the next Trans* Orientation Sessions for trans* folk to come in and learn about Apicha CHC’s Trans* Health Clinic.
This NYC medical clinic is for the specific needs of transgender and gender non-conforming, gender variant and genderqueer individuals.
Our Trans*Health services include:
- Personalized Primary Care
- Routine Check-Up and Immunization
- Initiation and Maintenance of Hormone Therapy
- Short-Term Mental Health Services
- Care Management
- Trans* Groups
Please feel free to request an appointment or stop by a Trans* Orientation Session to learn more about trans* health, Apicha CHC’s Trans* Health Clinic, and trans* insurance coverage.