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P E R S P E C T I V E : L e t t e r F r o m t h e E d i t o r
The Gender Issues
Permeating PrEP
The focus of PrEP — including PrEP on Demand in New York City — has often been focused on cisgender men
who have sex with men.
BY MATT TRACY
Two years ago, the New York
City Department of Health
and Mental Hygiene rolled
out new guidelines pertaining
to the daily HIV prevention
medication known as PrEP. Health
offi cials brought forward an alternative
option, “PrEP on Demand,”
in which people could take the pill
around their sexual schedule instead
of daily. It was suitable for those who
had trouble affording the cost of daily
PrEP, had sex inconsistently, or had
diffi culty taking a pill every day.
But there was a catch: PrEP on Demand
was only studied and endorsed
for cisgender men who had sex with
men. Years later, those guidelines
remain the same, meaning transgender
individuals, some non-binary
folks, and cisgender women continue
to be left out of the PrEP on Demand
discussion entirely.
The limitations of PrEP on Demand
represent a broader issue in HIV prevention
efforts. People of marginalized
genders are, in many ways, left
out when it comes to PrEP.
Descovy and Truvada, for example,
WIKIMEDIA COMMONS/NIAID
are both approved for PrEP, but the
Food and Drug Administration has
only approved Descovy for cisgender
men who have sex with men and
transgender women. The city health
department’s website even states that
Descovy may not be appropriate for
cisgender women or transgender men
due to the lack of research regarding
Descovy’s ability to prevent HIV during
receptive sex.
Many of these gender-based disparities
— which stem from early studies
focusing on cisgender men who have
sex with men — will likely be addressed
upon the completion of more
research, which is indeed underway,
including studies examining the effectiveness
of infrequent HIV prevention
shots among cisgender women.
Plus, there are options, such as Truvada,
which is recommended as a
“fi rst-line formulation for PrEP in all
populations at risk of HIV exposure,”
health department spokesperson Pedro
Frisneda told Gay City News.
Still, there are fewer options for
certain demographics and only cisgender
men are approved for PrEP
on Demand at a time when people of
marginalized genders continue to be
impacted by disparities surrounding
HIV/AIDS. According to the Centers
for Disease Control and Prevention’s
(CDC) statistics from 2019-2020, 42
percent of transgender women are
living with HIV in the United States.
And only seven percent of women in
general who could benefi t from PrEP
in 2018 were prescribed it, according
to the CDC.
Adding to the problem is the reality
that many doctors remain unprepared
to care for patients who could
benefi t from PrEP. Carl Schmid, who
is a member of the Presidential Advisory
Council on HIV/AIDS and
serves as the executive director of the
HIV+Hepatitis Policy Institute, said
during an interview with Gay City
News last month that a new campaign
to roll out private sector HIV
prevention efforts nationwide will
include efforts to educate doctors because
so many are not equipped to
deal with PrEP.
Furthermore, even with the growth
of cost-sharing, generic PrEP, and
other efforts to reduce or eliminate
the costs of HIV prevention medication,
not all populations are covered
and cost remains a factor. If PrEP on
Demand is intended to help those
who are struggling to afford their
daily PrEP, it’s not being marketed to
the at-risk women who face the most
fi nancial instability. Women classifi
ed as living in “medium poverty”
made up the largest share of HIV
diagnoses in New York City among
women in 2020, followed by women
in “very high” poverty and “high”
poverty, according to the city health
department. Among women between
the ages of 13 and 59 who received
an HIV diagnosis in 2020, 30.8 percent
were Black — which was more
than twice as high as the numbers
for Latinx/Hispanic women or multiracial
women.
The intersectional impact of the
exclusion from HIV prevention efforts
adds to existing racial disparities
among men who have sex with men
and are living with HIV. According to
the CDC, 62 percent of Black trans
women were living with HIV in 2018.
The city health department’s 2020
HIV Surveillance Annual Report,
which was unveiled on World AIDS
Day, December 1, celebrated a 62
percent dip in new HIV infections
among heterosexual women. While
those gains are notable, more work
is needed to make sure people of all
genders are consistently included in
HIV prevention efforts.
December 3 - December 15, 2 10 021 | GayCityNews.com
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