CHALLENGES IN ADHERENCE TO HIV PRE-EXPOSURE PROPHYLAXIS (PREP) AMONG TRANSVESTITE AND TRANSGENDER POPULATIONS IN A MUNICIPALITY OF GREATER SÃO PAULO

Access to HIV pre-exposure prophylaxis (PrEP) in Brazil remains unequal. Transvestite and transgender people still face access barriers due to multiple factors such as stigma and discrimination in healthcare settings. To describe the demographic profile of PrEP users from a specialized transgender health clinic in Greater São Paulo and report the main causes of discontinuation of this prevention technology. Data were collected between September 15, 2021, and May 31, 2025, and analyzed according to gender identity, education, race/color, age, and follow-up status. Data were tabulated using Microsoft Excel 97. Of the 461 users enrolled during this period, 228 were trans men (TM), 212 were trans women and transvestites (TWT), and 21 were non-binary/gender-fluid individuals (NBGF). Among them, 417 tested HIV-negative (potentially eligible for PrEP). Of these, 8.15% (n = 34) initiated PrEP at admission, identifying TWT as the most vulnerable group (70.6%), followed by TM (8.8%) and NBGF (20.6%). The mean age was 29 years; 50% had completed secondary education, 17% had started higher education, 29% had completed primary education, and 4% had incomplete primary education. Regarding race/color, 47% identified as White, 44% as Black or mixed-race, 6% as Asian, and 3% as Indigenous. 44% maintained regular adherence, while 56% discontinued PrEP. Seven participants reported no longer feeling vulnerable because they were in stable relationships or not sexually active; four discontinued due to nausea and other gastrointestinal discomforts; seven were lost to follow-up and reported difficulties in accessing the service; and one HIV infection occurred. Many users did not use PrEP because they did not perceive themselves as vulnerable to HIV – either due to sexual inactivity, self-image issues, stigma, or a lack of risk perception – along with factors such as trust in partners, alcohol and drug use, or unawareness of this prevention technology. Integrating hormone therapy services with HIV prevention helps facilitate access and adherence. Increasing risk perception in this population remains challenging. It is important to develop additional forms of prophylaxis beyond the oral route. In this context, the advent of injectable PrEP strategies may revolutionize adherence in this population. The development of further studies is essential to reduce barriers and decrease HIV vulnerability in this group.