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Healthcare visits for transgender-related diagnoses and gender-affirming hormone therapy (GAHT) have been rising, researchers reported, suggesting it as an opportunity for HIV prevention.

Within a commercial health plan database, the proportion of adults with a transgender-related diagnosis code increased by 30.8% each year from 2014 to 2021 (13.4 to 113.9 per 100,000 enrolled persons) for an overall ninefold increase in prevalence.

These increases were mainly driven by younger people, with an estimated annual increase of 35.8% during the study period for those from the ages of 18 through 24, Ya-Lin A. Huang, PhD, MS, of the CDC's Division of HIV Prevention in Atlanta, and colleagues reported in .

Of those with a transgender-related diagnosis code, the proportion prescribed GAHT rose from 30.5% in 2014 to 43.4% in 2021.

The rising trends didn't come as a surprise, Huang told MedPage Today. "This increase was likely driven by [ACA], which prohibits discrimination in healthcare plans based on a number of characteristics, including sex, which includes: pregnancy, sexual orientation, gender identity, and sex characteristics."

"In addition, over the study period, sociocultural changes resulted in increased acceptance of transgender and gender-diverse identities," she added.

As GAHT was quickly picking up during this time, so was HIV testing. For those deemed at risk of sexually transmitted infection (STI), the HIV testing rate increased from 52.9% to 61.1% from 2014-2021 among transgender women and from 32.0% to 48.3% among transgender men.

Prescriptions for preexposure prophylaxis (PrEP) also increased among those at-risk individuals screened for HIV. These prescriptions increased from 1.0% in 2014 to 20.2% in 2021 among transgender women and from 0.0% to 10.2% among transgender men.

While "encouraged" to see the rise in HIV testing and PrEP, Huang's group wrote that "prevalence of clinical encounters for GAHT was notably higher than the prevalence of HIV testing, suggesting that clinical encounters for GAHT may provide opportunities for additional HIV prevention services."

"Since 2021, that all persons be informed about HIV prevention with PrEP and be prescribed PrEP if they request it," Huang noted in correspondence with MedPage Today. "Gender-affirming care encounters could be a gateway to bolstering HIV prevention services, including testing and PrEP, and primary care to transgender and gender-diverse populations. Healthcare providers will likely continue to see more patients seeking gender-affirming care and should be prepared to provide care according to the ."

Data for the retrospective analysis came from the Merative MarketScan commercial databases, covering some 30-50 million people enrolled in employer-sponsored health insurance plans. The transgender cohort included people 18 and older with an ICD-9 or -10 diagnostic code for gender identity disorder or gender dysphoria. That number rose from 16,083 in 2014 to 142,782 in 2021.

In 2021, there were 54,409 persons identified with both a transgender-related diagnosis and a GAHT prescription. Of these, 74.5% were prescribed feminizing GAHT and categorized as transgender women, and 25.5% were prescribed masculinizing GAHT and categorized as transgender men.

Two-thirds of transgender women had their sex listed as male in the database, and most were from the ages of 18 through 34, lived in an urban area, and resided in the West. Around 2.4% had an HIV diagnosis and 26.2% had an STI test or diagnosis.

About 61% of transgender men had their sex listed as female in the database, and more than half of them were ages 18 through 24. Of this group, 0.2% had an HIV diagnosis and 30.1% had STI risk.

Huang's group pointed out that because this dataset only included those with employer-sponsored health insurance, these numbers can't be generalized to the overall U.S. population.

"We likely underestimated the total number of transgender persons with commercial health insurance in the United States because our study did not include those who did not receive a transgender-related diagnosis or did not seek health care services for GAHT," they said.

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