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PrEP is one of the most effective tools we have to prevent HIV, yet many people still have questions about what it is, who it is for, and how it fits into their lives. Can you take PrEP if you are on gender-affirming hormone therapy? Does it have side effects? And why do so many transgender and gender-diverse people still face barriers to accessing it?We consulted the IPPF International Medical Advisory Panel to answer some of the most common questions we have received from the community about PrEP, from how it works and who can benefit from it, to the realities of navigating HIV prevention, healthcare systems, and gender-affirming care. Whether you're considering PrEP yourself, supporting someone who is, or simply curious, here's what you need to know.What is PrEP? PrEP refers to the use of antiretroviral medication by people not infected with HIV to reduce their risk of acquiring HIV (1). PrEP is used during periods when individuals believe they are particularly vulnerable to HIV infection. There are different delivery methods and regimens, with new methods also in development. Currently available options include an oral pill, a vaginal ring, and long-acting injectables. Who should use PrEP? PrEP is appropriate for anyone who perceives themselves to be vulnerable to HIV and wishes to reduce their risk of HIV infection through use of medications (1). Are there side effects to PrEP? Like all medications, PrEP may be associated with side effects in some people. The most common side effects are temporary, and can include nausea, bloating, diarrhoea, headache, feeling dizzy or weak, and trouble sleeping. Side effects from injections can include bruising, pain or small nodules at the injection site. Serious side effects are rare. Does PrEP interfere with gender-affirming hormone therapy? No. PrEP does not lower hormone levels in transgender, nonbinary, and gender diverse people (TGD) on gender-affirming hormone therapy (GAHT) (2). PrEP has been shown to be effective and safe in TGD people and should be provided to high-risk individuals regardless of gender affirming hormone use. There are no measurable differences in hormone levels in blood between PrEP users and non-users who are on GAHT (3). However, blood concentrations of PrEP drugs in transgender women were lower than expected, although at levels unlikely to interfere with their antiviral effect to prevent HIV acquisition (4). Are there sexual side effects to PrEP or gender-affirming hormone therapy for transgender women? PrEP is a medication that reduces the ability of the HIV virus to infect human immune cells; it does not impact the sexual functioning of human sex organs. GAHT for transgender women, however, decreases penile erection function, libido and ejaculatory volume. Discussion of these effects should be an integral part of the informed consent process and shared decision-making at the time of initiating GAHT. If these particular effects are unwanted, there are various strategies that can be used for those who wish to fully maintain penile sexual function, including the use of PDE5 (phosphodiesterase type 5) inhibitors (e.g., sildenafil, tadalafil, vardenafil) to facilitate erections, masturbation/sexual activity to maintain tissue perfusion, lowering antiandrogen doses when feminising goals are met and targeting testosterone levels slightly higher than cisfemale range (either through lower GAHT doses or addition of low-dose add-back testosterone therapy) (5). What are the barriers to using PrEP? Access to healthcare is critical for successful PrEP implementation. Although higher-income regions have had more successful implementation and awareness raising campaigns to date, many low-middle income countries are accelerating access. While PrEP is an important part of HIV preventive care services, studies show transgender women use less preventive care due to multiple factors, including limited access to healthcare, lack of insurance coverage for PrEP and gender-affirming care and medications, and fear of discrimination and stigma by healthcare providers (6). References IMAP statement on biomedical HIV prevention. IPPF, 2023 IMAP Statement on Biomedical HIV Prevention | IPPF, accessed March 2026. Senneker T. Drug-Drug Interactions Between Gender-Affirming Hormone Therapy and Antiretrovirals for Treatment/ Prevention of HIV. Br J Clin Pharmacol. 2024;90:2366–2382. Grant RM, Pellegrini M, Defechereux PA, Anderson PL, Yu M, Glidden DV, O’Neal J, Yager J, Bhasin S, Sevelius J, Deutsch MB. Sex Hormone Therapy and Tenofovir Diphosphate Concentration in Dried Blood Spots: Primary Results of the Interactions Between Antiretrovirals And Transgender Hormones Study. Clin Infect Dis. 2021 Oct 5;73(7):e2117-e2123. doi: 10.1093/cid/ciaa1160. PMID: 32766890; PMCID: PMC8492111. Hiransuthikul A, Janamnuaysook R, Himmad K, et al. Drug drug interactions between feminizing hormone therapy and preexposure prophylaxis among transgender women: the iFACT study. J Int AIDS Soc 2019; 22(7): e25338. DOI: 10. 1002/jia2.25338. Sehgal I. Review of adult gender transition medications: mechanisms, efficacy measures, and pharmacogenomic considerations. Front Endocrinol (Lausanne). 2023 Jul 4;14:1184024. doi: 10.3389/fendo.2023.1184024. Teng F, Sha Y, Fletcher LM, Welsch M, Burns P, Tang W. Barriers to uptake of PrEP across the continuum among transgender women: A global scoping review. Int J STD AIDS. 2023 Apr;34(5):299-314. doi: 10.1177/09564624231152781. Epub 2023 Feb 15. PMID: 36793197.

Mpox is a viral zoonotic disease which typically occurs in tropical areas in central and west Africa. From May 2022-July 2023, multiple cases of mpox were identified in non-endemic countries, and the World Health Organization declared the mpox outbreak a Public Health Emergency of International Concern. This marked the first time many mpox cases were reported concurrently in non-endemic and endemic countries in different geographical areas. During the outbreak, nearly 100,000 people were infected, primarily gay and bisexual men, and approximately 200 people died.  This statement was prepared by Nathalie Kapp, Chief Medical Advisor with support from the International Medical Advisory Panel (IMAP) members: Arachu Castro, Michalina Drejza, Gail Knudson, Zozo Nene, Prof. Pascale Allotey, Janet Meyers, Professor Michael Mbizvo (Co-Chair), Chipo Gwanzura (Co-Chair), Paul D. Blumenthal, and Edmore Munongo. We thank the panel for their valuable and timely guidance and reviews offered during the development process. 

This statement is intended to support and guide IPPF Member Associations and other sexual and reproductive health and rights (SRHR), humanitarian and development organisations regarding COVID-19 and vaccination and the impact on delivery of sexual and reproductive healthcare (SRH). It covers issues related to advocacy to address health inequalities and stigma, in addition to medical and service delivery recommendations, evidence and practical guidance from the scientific community. 

IPPF understands abortion self-care as the right of women and girls to lead, in part or entirely, their abortion process, with or without support from health providers. Guided by the existing evidence and practices, this statement provides practical recommendations for IPPF Member Associations and other sexual and reproductive health stakeholders on how to manage abortion care within a people-centred model which empowers individuals and is supported by community collectives and social networks, however still backed-up by the healthcare system whenever needed or required. This statement also serves as an advocacy tool to create an enabling environment for abortion self-care.    

Achieving UHC represents an ambitious global effort which currently receives significant traction and political momentum. Although each country is at a different stage of implementation, as they take steps on the path towards UHC, new opportunities arise to advance and integrate a comprehensive approach to SRHR and essential SRH services. UHC reforms are inherently complex, but a people‑centred and a health systems approach can help to identify key areas and actions that can be taken to advance SRHR integration in UHC. This IMAP statement highlights some of these areas and actions and, as a deeper understanding of local circumstances and the specific needs of those currently left behind are crucial, IPPF MAs are well placed to play a leading role in this process.

It is estimated that 1 in 3 (35%) women worldwide have experienced physical and/or sexual violence from an intimate partner and/or sexual violence by a non‑partner in their lifetime, with the majority of this violence being intimate partner violence. Of the 87,000 women who were killed intentionally in 2017 globally, an estimated 58% were killed by an intimate partner or family member.Sexual and gender‑based violence (SGBV) is a human rights violation, associated with death, injury and a broad range of negative sexual, mental and physical health issues and socio‑economic impacts.

This statement’s purpose is to provide guidance to IPPF Member Associations and other sexual and reproductive health and rights (SRHR)organizations to support sustained provision of essential and life‑saving SRH services in the context of the COVID‑19 pandemic. The statement also serves as a tool to advocate with donors and other stakeholders for additional resources to sustain SRH services throughout the pandemic. The statement reinforces IPPF’s position and commitment to SRH and rights and gender equality.

In 2018, IPPF endorsed the WHO/UNFPA Call to Action to Attain Universal Health Coverage Through Linked Sexual and Reproductive Health and Rights and HIV Interventions.13 This IMAP statement serves as a reminder of this call to action to ensure all people have access to comprehensive SRH services, including integrated contraceptive and HIV/STI services, provided through primary healthcare.

The body of evidence on possible increased risk of HIV acquisition with use of progestogen‑only contraception has remained mixed since 1991, with the greatest concern of an increased risk of HIV acquisition centred on the use of intramuscular depot‑medroxyprogesterone acetate (DMPA‑IM). Data on the risk of HIV acquisition and use of other highly effective contraceptives such as norethisterone enanthate (NET‑EN), hormonal implants, and hormonal and non‑hormonal IUDs are limited.2 And there are no data on subcutaneous DMPA (DMPA‑SC) and HIV risk.  In 2016, an updated systematic review of epidemiological evidence on hormonal contraception and HIV acquisition concluded that there was a significant association between the use of DMPA and HIV acquisition and no increased HIV risk with oral contraceptive pills.3 The updated systematic review provided important data regarding DMPA users at high risk of HIV; however, confounding in these observational data could not be excluded. The historically mixed data and the need to control for confounding required further investigation into the association between use of progestogen‑only injectables and increased risk of HIV acquisition, using a more robust research design. This led to the development of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial.  

Lack of access to safe abortion care is further exacerbated in many settings by stigma, a lack of knowledge on sexual and reproductive health and rights (SRHR),3 and what the Guttmacher‑Lancet Commission on Sexual and Reproductive Health and Rights calls “a persistent discrimination against women and girls, and an unwillingness to address issues related to sexuality openly and comprehensively.”4 Particularly vulnerable groups within this context are adolescents; women with disabilities; sex workers; women who are subjected to forced marriage, domestic violence, abuse or rape, or female genital mutilation; and women subjected to human trafficking. Medical abortion has the potential to increase access to safe abortion care and to increase women’s autonomy and decision‑making with regards to their reproductive choices and rights. It is time to implement evidence‑based abortion services that promote, protect and fulfil the sexual and reproductive rights of all individuals everywhere.