Disclosure of gender identity and history is not necessary for the provision of PEP and should always be optional. This is particularly important for patients with transgender experience, non-binary, or fluid gender identities.

Evidence for HIV prevalence and risk among trans and gender-diverse people in Australia is poor due to limitations with data collection and recording of trans and gender-diverse status.^107,108 Internationally, trans and gender-diverse people are often disproportionally affected by HIV.¹⁰⁹ The focus of the PEP risk assessment needs to be knowledge of the potential HIV risk of the source, and type of exposure, rather than the patient’s gender identity.

It is important for clinicians not to make assumptions about a patient’s gender identity, the type of sex they have, or the level of risk associated with that sex. As for any person presenting for PEP, the risk assessment should be based on the risk of the source being HIV positive, on treatment and being virally suppressed, the sexual contact which occurred and led to the presentation for PEP and any co-factors which may increase the risk (see Table 2).

Clinical practice tips include:

• clinicians should ask patients their preferred name, pronouns, and preferred names for anatomical sites (e.g. this could be front hole rather than vagina)
• use open-ended questions to allow patients to choose what information they disclose about the types of sexual interaction they engage in
• guidance for people who have receptive vaginal, frontal or neovaginal intercourse who are taking PEP or PrEP is outlined in sections: People who re-present with additional high risk exposure(s) while taking a PEP course, Table 5, and People who are transitioning from PEP to PrEP.
• all recommended PEP regimens are expected to have no significant drug-drug interactions with gender-affirming hormones. Where there is need for an alternative PEP regimen, interactions with antiretroviral therapy and gender-affirming hormones can he found on the Liverpool HIV Drug Interactions checker website.

For further advice, refer to:

• Transhub
• Australian STI Management Guidelines for Use in Primary Care