# Gender-Affirming Care as a Predictor of HIV Pre-Exposure Prophylaxis Use and Adherence Among Young Trans Feminine Adults: A Coincidence Analysis

## TL;DR

This study shows that gender-affirming care, especially hormone replacement therapy, is linked to higher HIV PrEP use and adherence among young trans feminine adults.

## Contribution

The study identifies specific forms of gender-affirming care and insurance status as novel predictors of PrEP use and adherence in trans feminine youth.

## Key findings

- Hormone replacement therapy or parental insurance predicted PrEP use in over 90% of cases.
- Two models showed how puberty blockers and HRT, combined with insurance status, influenced PrEP adherence.
- Integrated and accessible gender-affirming care is crucial for improving PrEP uptake and adherence.

## Abstract

We used coincidence analysis to explore whether various forms of gender-affirming care (GAC) in the presence or absence of medical mistrust facilitate HIV pre-exposure prophylaxis (PrEP) use and adherence. Using secondary data collected between 2014 and 2024 from the RADAR Cohort Study, we performed two crisp-set coincidence analyses with 86 trans feminine young adults for PrEP use and 24 trans feminine young adults for PrEP adherence. Our final model for PrEP use explained over 90% of participants who had used PrEP in the past 6 months with 60% consistency. This model identified receipt of hormone replacement therapy (HRT) OR being on parental insurance as predictors of PrEP use. We identified two final models for PrEP adherence, which explained 50% of participants with 83% consistency: (1) past receipt of puberty blockers OR high suspicion of medical providers in the absence of parental insurance; (2) current or past receipt of HRT in the absence of barriers to GAC and the absence of parental insurance. Our study highlights the significant role of GAC in facilitating PrEP use and adherence among trans feminine individuals. Specifically, HRT and the absence of parental insurance emerged as key predictors, underscoring the need for integrated and accessible GAC to enhance PrEP uptake and adherence in this population.