In the ongoing global effort to stave off the HIV epidemic, certain marginalized populations remain disproportionately affected and underserved despite advances in biomedical prevention strategies. Recent research carried out in Spain sheds new light on the glaring inequities faced by transgender and non-binary individuals in accessing and utilizing key HIV prevention interventions. A comprehensive cross-sectional survey analyzed awareness and uptake of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), two cornerstone biomedical tools that have revolutionized HIV prevention worldwide. The findings reveal significant disparities that urgently demand both policy and healthcare practice reforms to bridge these gaps and promote health equity.
Trans and non-binary people constitute an epidemiologically critical subgroup, often experiencing a complex interplay of biological, social, and structural vulnerabilities that increase their risk of acquiring HIV. Despite this heightened vulnerability, their representation in clinical research and public health initiatives remains limited. The Spanish study offers valuable insights by systematically evaluating knowledge of and engagement with PrEP and PEP — interventions that, when properly accessed and adhered to, can dramatically reduce the incidence of HIV transmission. This study’s cross-sectional design enabled broad population-level assessment at a critical point during the scale-up of these prevention modalities.
The survey encompassed a diverse cohort of trans and non-binary individuals across Spain, capturing variations across age, geographic region, socioeconomic status, and gender identity spectrum. Participants were assessed regarding their awareness of PrEP and PEP, perceived barriers, sources of information, and actual use of these medications. The comprehensive data collection efforts accounted for social determinants such as healthcare accessibility, stigma, and discrimination — factors widely recognized to impede prevention efforts in sexual and gender minority populations.
Key findings from the study indicate that although awareness of PrEP and PEP is rising among trans and non-binary individuals in Spain, a large fraction remains uninformed or misinformed about these tools. Crucially, awareness did not translate seamlessly into use, identifying a pronounced gap between knowledge and implementation. Several obstacles emerged, including lack of culturally competent healthcare providers, financial and bureaucratic barriers, fear of discrimination within clinical settings, and community-level stigma. These systemic challenges compromise equitable rollout and highlight the need for tailored interventions.
Biomedical prevention technologies like PrEP require sustained engagement with healthcare systems. The study underscores the lack of trans-specific protocols and services that accommodate non-binary identities, which exacerbates disengagement. For instance, many trans individuals expressed concerns about hormone therapy interactions or anticipated transphobic attitudes from clinicians, undermining trust. Therefore, integration of PrEP education and provision within gender-affirming care spaces was suggested as an effective strategy to enhance uptake and retention.
In examining PEP, typically administered after potential HIV exposure, similar trends of low awareness and limited use were observed. Since PEP efficacy depends on rapid initiation post-exposure, delayed knowledge or access further attenuates its preventive potential for this population. The study calls for enhanced community outreach and emergency healthcare protocols attuned to trans and non-binary individuals’ unique contexts to optimize PEP delivery.
Beyond medical and logistical barriers, the research illuminated broader social determinants, including internalized stigma, mental health disparities, and socioeconomic instability, all of which intersect to curtail HIV prevention efforts. These findings aligned with the minority stress model, which explains how chronic exposure to prejudice exacerbates health vulnerabilities. Addressing these upstream determinants requires a multisectoral approach, combining social support, anti-discrimination policies, and inclusive sexual health education.
Policy implications from this research are profound. Despite Spain’s progressive measures on LGBTQ+ rights and universal healthcare coverage, significant gaps in HIV prevention among trans and non-binary people persist. The study advocates for national HIV strategies explicitly incorporating gender-diverse populations, backed by targeted funding and accountability mechanisms. Moreover, training healthcare professionals in trans-competent care and fostering partnerships with community organizations were identified as critical enablers.
From a biomedical perspective, this study reiterates the necessity of patient-centered approaches that respect gender identity and address unique pharmacological considerations. Emerging data on PrEP pharmacokinetics in transgender people indicate potential variations requiring tailored dosing or monitoring — a frontier that clinical trials need to explore rigorously. The Spanish survey highlights the urgency of integrating these scientific nuances into practice to avoid exacerbating disparities.
The researchers underscore the transformative potential of digital health technologies in expanding awareness and access. Mobile health platforms, telemedicine, and online peer support can mitigate geographic and social barriers, providing discreet and affirming spaces for information dissemination and service delivery. Harnessing these tools aligns with global trends toward decentralized, user-friendly health interventions, especially beneficial for populations facing stigma.
Equally important is community empowerment. The study documented that trans-led initiatives and peer navigation significantly boosted engagement with HIV prevention services. These models emphasize trust-building and culturally congruent messaging, critical for overcoming mistrust rooted in historical healthcare neglect. Scaling up peer-led interventions alongside formal health systems integration represents a promising avenue for reducing inequities.
The Spanish study’s methodology, including robust sample sizes and mixed-methods approaches, enhances confidence in its conclusions while also highlighting areas warranting further inquiry. Longitudinal evaluations and integration of biomarker data could elucidate temporal trends and real-world efficacy. Additionally, expanding research beyond urban centers to rural or less resourced regions would strengthen understanding of geographic variability in prevention gaps.
This investigation contributes to the broader scientific discourse by emphasizing the intersectionality of HIV risk and prevention among gender minorities, a group often subsumed under broader LGBTQ+ epidemiological categories. Its granular focus affirms that one-size-fits-all public health strategies inadequately address the nuanced needs of trans and non-binary populations. Tailored solutions developed through participatory research paradigms are essential to closing existing chasms.
In conclusion, the inequities identified in HIV prevention efforts among trans and non-binary people in Spain present an urgent call to action. Bridging the divide between awareness and use of PrEP and PEP demands structural reforms, enhanced clinical competencies, and community partnerships. By centering the voices and experiences of gender-diverse individuals in HIV prevention science and policy, healthcare systems can move closer to realizing equitable access and improved health outcomes. This study lays a critical foundation for future interventions designed to dismantle persistent barriers and accelerate progress toward ending the HIV epidemic in all populations.
Subject of Research: Inequities in HIV prevention among transgender and non-binary individuals with respect to PrEP and PEP awareness and usage in Spain.
Article Title: Inequities in HIV prevention among trans and/or non-binary people: a cross-sectional survey analysis of PrEP and PEP awareness and use in Spain.
Article References:
Moreno-García, S., González-Recio, P., Donat, M. et al. Inequities in HIV prevention among trans and/or non-binary people: a cross-sectional survey analysis of PrEP and PEP awareness and use in Spain. Int J Equity Health 24, 197 (2025). https://doi.org/10.1186/s12939-025-02574-4
Image Credits: AI Generated
