A Decade of Improvement and Signs of Decline in PrEP Awareness and Use in Young Trans Women

The risk of HIV is significantly higher in transgender women compared to the general population, with young trans women having higher incidence compared to older trans women. Effective efforts to ensure PrEP uptake and persistence among young trans women is key to addressing the HIV epidemic in the U.S. We analyzed serial cross-sectional data from the Trans women Empowered to Advance Community Health (TEACH) studies conducted in San Francisco in 2013, 2016-2017, 2019-2020, and 2023-2024. Our study included 83 young adult (18-26 years old) trans women living without HIV. We used the Cochran-Armitage test for trends to assess changes in PrEP awareness, use, and key HIV risk and preventive behaviors. PrEP awareness among young trans women significantly increased from 6% in 2013, 94% in 2016-2017, 100.0% in 2019-2020, and 86% in 2023-2024 (z = 7.96, p < 0.001). PrEP use also significantly increased from 0% in 2013, 19% in 2016-2017, 46% in 2019-2020, and 36% in 2023-2024 (z = 9.90, p < 0.001). Meanwhile, condomless sex in the last 12 months has risen from 33% in 2013 to 86% in 2023-2024 (z = 4.15, p < 0.001). PrEP awareness and use have significantly increased among young trans women in San Francisco since FDA approval in 2012. However, our study points to a potential leveling off or decrease in PrEP awareness and use in recent years. Furthermore, PrEP use still lags need. Young trans women must be prioritized in PrEP awareness and demand creation efforts in addition to efforts to support adherence and persistence.