LAUSR

Background Trans and gender diverse (TGD) individuals are at higher risk of HIV than the general population. TGD individuals are under-represented among HIV pre-exposure prophylaxis (PrEP) users, hence little is known about their pill-taking behaviours. We describe demographic characteristics and PrEP adherence by TGD individuals in the EPIC-NSW study. Methods From March 2016 to April 2018, 9,708 individuals were enrolled in EPIC-NSW. At baseline, then quarterly, participants were invited to complete an optional online behavioural and adherence survey. Factors previously associated with lower PrEP adherence were compared between TGD and non-TGD participants using chi-squared tests. Results Of the 6,942 EPIC-NSW participants that completed any survey, 96 identified as TGD (1.4%), including 38 trans women and 15 trans men. TGD participants were significantly younger than non-TGD individuals (mean 34 vs 39 years, p<0.001) and less likely to be university educated (44% vs 60%, p=0.002). TGD individuals were more likely to identify as Indigenous Australian (11% vs 2%, p<0.001), although no more likely to have been born in Australia (p=0.634). 52% of TGD individuals reported being paid for sex by a man in the previous three months, compared to 8% of non-TGD participants (p<0.001). TGD participants were as likely as other participants to report using crystal methamphetamine (p=0.666), party drugs (p=0.572), or condomless sex in the previous three months (p=0.991). Taking at least four or seven PrEP pills in the previous week was reported in 87% and 91% (p=0.071) and 77% and 82% (p=0.06) of surveys completed by TGD and non-TGD individuals, respectively. Conclusion Despite increased levels of HIV-risk and socio-economic disadvantage, TGD participants had comparable levels of adherence to non-TGD EPIC-NSW participants. Additional services for TGD including counselling and PrEP monitoring within a supportive environment may be warranted to ensure ongoing protection against HIV. Disclosure No significant relationships.