Examining Disruptions in Access to HIV Prevention Care

Nearly two-thirds of transgender and nonbinary adults surveyed across five US states reported disruptions to HIV prevention services during the first months of 2025. Results of the survey were published in The Lancet Regional Health – Americas.In the study, researchers analyzed cross-sectional data from the Priority Assessment in Trans Health Across States (PATHS2) survey, which was conducted between February and April 2025.

Assessing Care Disruptions Through a 5-State Survey
The analysis included 693 transgender and nonbinary adults aged 18 years or older who reported no known HIV diagnosis and had used HIV prevention services, including pre-exposure prophylaxis (PrEP) or HIV testing, within the previous 12 months. Participants were recruited from Connecticut, New York, Washington, Georgia, and Utah.

Investigators assessed four types of self-reported disruption: delayed or denied HIV prevention medication, loss of insurance or financial assistance, reduced service availability, and increased healthcare stigma. Multivariable logistic regression examined factors associated with any disruption, while ordinal logistic regression assessed the breadth of disruptions experienced.

Discrimination Emerges as the Strongest Correlate
Overall, 64.5% of participants reported at least one HIV prevention service disruption. Among these individuals, 25.5% experienced significant disruption, defined primarily as three or more disruption types.

The most frequently reported disruptions were delayed or denied medication (53.2%), reduced service availability (50.3%), loss of coverage or financial assistance (40.9%), and increased healthcare stigma (29.3%).

Past-year discrimination demonstrated the strongest association with disruptions to HIV prevention care. Compared with participants reporting fewer than nine discriminatory events in the previous year, those reporting nine or more had significantly higher odds of experiencing any disruption (adjusted odds ratio [aOR]=16.5; p<0.0001) and greater number of disruption types (aOR=9.68; p<0.0001).

Disparities also emerged across demographic groups. Compared with transgender men, transgender women had higher odds of experiencing any disruption (aOR=2.69; p=0.0009). Black or African American participants similarly had higher odds than White participants (aOR=2.17; p=0.033).

Although nonbinary participants did not have significantly higher odds of overall disruption, they demonstrated elevated odds across all four individual disruption categories, including increased healthcare stigma (aOR=6.58; p<0.0001).

Positive anxiety and depression screens were also independently associated with disruption of care. However, the cross-sectional design could not determine whether psychological symptoms preceded or followed difficulties accessing care.

What the Findings Mean for HIV Prevention
One unexpected finding was that residence by state was not significantly associated with fewer disruptions after adjustment for other factors.

Limitations included recruitment through social media and community networks, which may limit the generalizability of the findings, and reliance on self-reported experiences.

Nevertheless, the findings identify substantial gaps in HIV prevention access and highlight populations reporting disproportionate disruption. The authors recommend strengthening healthcare nondiscrimination enforcement, maintaining PrEP coverage and prescription assistance, and supporting community-led HIV prevention services. Longitudinal research will be essential to determine how these patterns evolve and the efficacy of efforts to reduce sustained disruptions in HIV prevention care in these populations.

Reference:
Restar AJ, et al. Lancet Reg Health Am. 2026;63:101591. doi:10.1016/j.lana.2026.101591