2061. High Rates of Viremic HIV, Risky Sexual Behaviors, and Interest in Gender Affirming Hormone Therapy among Transgender Individuals Who Engage in Transactional Sex
Authors: Cover Amelia A , Eyasu Rahwa , Davis Ashley , Harfouch Omar , Ebah Emade , Bijole Phyllis , Gannon Catherine , Garrett Grace , Wang Vivian , Spikes Michelle , Imani F N U , Jones Miriam , Masur Henry , Kottilil Shyam , Kattakuzhy Sarah , Rosenthal Elana S 
Published: December 2022

Abstract

Background
In the U.S., HIV transmission persists largely through sexual transmission in gender and sexual minorities. Transactional sex (TS) is a known risk factor for HIV transmission, yet risk behaviors and engagement in HIV treatment and other medical services among transgender (TG) individuals who have TS are poorly understood.

Methods
PATCH is a natural history study of TG individuals in Washington, DC. Participants complete laboratory testing and surveys, including assessment of TS – defined as previous year sex in exchange for drugs, money or shelter. Fisher’s exact test was used for statistical analysis.

Results
Of 54 participants assigned male at birth (AMAB), 21(39%) endorsed TS, the majority of whom were female (81%), Black (95%), median age 35, and HIV+ (76%; Table 1). Of those with HIV, 12 (75%) were prescribed ART, though only 8 (50%) had HIV VL &lt; 200.
The majority of TG people with TS had sex weekly or more (75%), with &gt; 5 partners/year (62%) and used their penis (80%) and anus (90%) during TS. A minority consistently used condoms in receptive anal sex (29%), penetrative anal sex (25%), penetrative vaginal sex (17%), and chem sex (8%).
While 95% had ever taken gender affirming hormone therapy (GAHT), 62% were not prescribed GAHT at screening, of whom, 54% were interested in seeing a provider for GAHT.
When compared to non-TS participants, TG individuals with TS were more likely to have chem sex (p&lt; 0.01), use drugs daily or more (p=0.04), use amphetamines (p&lt; 0.01) and cocaine (p&lt; 0.01), and less likely to have GAHT prescribed by a provider (p=0.03). HIV+ patients with TS were less likely to have HIV VL&lt; 200 (p=0.02). Table 1:Participant Characteristics and Associations with Transactional Sex

Conclusion
This cohort of AMAB TG individuals with TS had high rates of viremic HIV, and multiple risk factors for HIV transmission, including frequent condomless sex with multiple partners. Additionally, those with TS were more likely to have high risk drug use, indicating that novel strategies to decrease risk associated with chem sex, particularly stimulant use, should be prioritized. Further, nearly all TG participants with TS had taken GAHT, yet were less likely to get GAHT from a provider. As many had interest in seeing a provider for GAHT, co-locating GAHT with HIV treatment and prevention services could help providers engage this population and address HIV-related risks.

Disclosures
Shyam Kottilil, MD, PhD, Arbutus Pharmaceuticals: Grant/Research Support|Gilead: Grant/Research Support|Merck: Grant/Research Support|Regeneron Pharmaceuticals: Advisor/Consultant|Silverback Therapeutics: Advisor/Consultant|The Liver Company: Advisor/Consultant|Yufan Biotechnologies: Advisor/Consultant Sarah Kattakuzhy, MD, Gilead: Grant/Research Support Elana S. Rosenthal, MD, Gilead: Grant/Research Support|Merck: Grant/Research Support.