The association between hormone therapy and PrEP use among transgender women is unclear. Qualitative research suggests that hormone use may facilitate PrEP use for some, while others may prioritize hormone therapy or have concerns about hormone-PrEP interactions.
We analyzed data (collected March-May 2019) from 330 sexually active transgender women aged ≥15 years who resided in the US. We used bivariate multinomial regression to estimate the association between self-reported past-year hormone use (i.e., no hormone use, provider-prescribed hormone use, and non-prescription hormone use) with past-year PrEP use. We used Chi-squared (χ2) tests to compare past-year sexual practices (i.e., condomless anal intercourse [CAI], condomless vaginal intercourse [CVI], and transactional sex) and past-year healthcare engagement across the provider-prescribed and non-prescription groups.
Median age was 24 (IQR: 20,31) and 72.7% (240/330) of the sample was White, non-Hispanic. 104 (31.5%) participants reported no hormone use while 190/330 (57.6%) reported provider-prescribed and 35/330 (10.6%) reported non-prescription hormone use. 22 participants (6.66%) used PrEP. 115 individuals (34.85%) reported CAI, 128 (38.79%) CVI, and 29 (8.79%) engaging in transactional sex. 303 (91.8%) reported a past-year healthcare provider visit. Compared to no hormone use individuals, provider-prescribed participants had 10.78 times the odds (95% CI 1.42-81.94), and non-prescription participants had 9.65 times the odds (95% CI 0.97-96.09) of having used PrEP. There were no differences in PrEP use across the provider-prescribed and non-prescription groups. Among hormone-users (n=226),non-prescription individuals were more likely to have engaged in CAI (χ2=5.89, p=0.015) and transactional sex (χ2=15.31, p<0.001), while provider-prescribed individuals were more likely to have visited a health care provider (χ2=5.91, p=0.015).
Integrated hormone therapy and PrEP provision strategies may support health care engagement for individuals in the provider prescribed group who may not be taking PrEP and for encourage individuals in the non-prescription group who may be engaged in PrEP care to use provider-prescribed hormones.