^{Florent Jouinot from Aids-Hilfe Schweiz reports on AFRAVIH 2026 in Lausanne.}

In his speech, Gabriel Girard highlighted the scale of the inequalities. Globally, transgender people have a much higher prevalence of HIV than the general population. According to the unfortunately incomplete data available, transgender women are particularly affected: 8.5% are living with HIV, and this figure rises to nearly 40% in certain contexts.

But figures alone are not enough to understand the situation.

Institutional discrimination, violence and criminalisation play a major role in exposure to HIV and access to care. Even today, more than thirty countries officially criminalise trans identities. In many contexts, laws criminalising sex work further exacerbate the precariousness and exclusion of trans women.

The health consequences are direct:

• avoidance of testing due to fear of stigmatisation,
• disruptions in care,
• difficulties accessing prevention,
• poorer viral suppression among people whose identity documents do not match their lived gender.

Transphobia thus emerges as a major determinant of health.

“Transphobia is not an opinion, it is violence,” the sociologist reminds us, in an international context marked by a rise in reactionary rhetoric explicitly targeting trans people.

Gabriel Girard highlights five issues which, in his view, must be taken into account: 

1. Recognising that the vulnerabilities of trans people regarding HIV are intersectional (gender, sexuality, migration, sex work, precariousness, racism);
2. Building alliances in the face of the fascistisation of public debate and its consequences for trans people;
3. Ensuring the autonomy and sustainability of trans community mobilisations in an increasingly hostile global context;
4. Supporting the development of a culture of participatory research, by empowering community organisations to get involved;
5. Positioning ourselves as partners in each other’s struggles, and not merely as allies

Moving away from a “risk”-centred approach

Several presentations also challenged traditional approaches to HIV prevention.

For Chloé Pasin, talking about “at-risk groups” or “risky behaviours” confines people to rigid identity categories. This approach reduces individuals to their supposed exposure to HIV and suggests that the danger is inherent to their identity.

The researcher advocates for training professionals based on trust and empathy, as well as reducing prejudice—an approach rooted in lived realities and sex-positive values that examines real-life contexts:

• housing conditions;
• economic insecurity;
• violence, including sexual and institutional violence;
• access to healthcare, including gender-affirming and sexual health care;
• the ability to negotiate protection.

A change in language thus becomes a genuine clinical and political tool.

Instead of asking: “Are you part of a high-risk group?”, professionals are encouraged to explore the person’s life circumstances and available resources.

This approach aims to empower and foster autonomy rather than to instil guilt or deter people from seeking care.

Gender-affirming care as a gateway 

One of the strongest messages from the session concerns gender-affirming care.

Data from the US LEGACY cohort, covering over 8,000 trans people, show that gender-affirming hormone treatments are associated with:

• a reduced risk of HIV infection,
• and better viral suppression in people living with HIV.

For the speakers, these findings fundamentally shift the perspective.

“Offer gender-affirming care, because otherwise you will never open the door for PrEP.”

In other words: without access to respectful and affirming care, HIV prevention remains largely inaccessible.

This logic requires a rethink of services:

• integrating HIV PrEP into trans healthcare pathways and services;
• training healthcare professionals on gender issues;
• adapting opening hours and access arrangements;
• developing community-based models.

Experiences in Thailand with the Tangerine Clinic or in France, notably with Acceptess-T, show that these approaches build trust, reduce stigma and encourage continued care.

“PrEP à porter”: prevention developed with trans women

The “PrEP à porter” study, presented by Valentina Isernia, provides a concrete illustration of this approach.

Developed in Paris as part of a long-standing partnership between Bichat Hospital and the community organisation Acceptess-T, the programme targets trans women at high risk of HIV, the majority of whom are migrants, in precarious situations and sex workers.

The initiative combines:

• community mediation;
• social and legal support;
• material support through FAST, the Trans Social Aid Fund;
• psychological support;
• community screening for HIV, other STIs and viral hepatitis;
• consultations online or in person at the organisation’s premises;
• specialised medical consultations in hospital settings combining gender affirmation services, mental health and sexual health care, including HIV PrEP.

The profiles of the participants highlight the extent of their cumulative vulnerabilities:

• significant legal and economic precariousness leading to a reliance on social security that is constantly under threat;
• high exposure to violence;
• significant mental health needs;
• frequent use of silicone injections, leading to complications.

Despite this, initial results show that a multidisciplinary, community-based programme enables satisfactory retention on PrEP, which has historically been difficult among trans women.

The study also shows that engagement in prevention increases when social, psychological and legal-administrative needs are addressed simultaneously.

PrEP alone is not enough. It is the surrounding living conditions that determine the ability to remain in care.

A lesson for Switzerland

These findings resonate strongly with the challenges facing Switzerland. Whilst the legal context is different, trans people in Switzerland continue to face significant discrimination, including within healthcare, legal and administrative difficulties—particularly regarding health insurance—and inequalities in access to healthcare, including sexual health services.

For Swiss AIDS Foundation, several key lessons emerge clearly.

Firstly, gender-affirming care must be further integrated into HIV and STI strategies. Prevention pathways cannot be separated from overall health needs, nor from the expectations of those affected and their health priorities.

Secondly, community-based approaches ‘by and for’ trans people must be strengthened. The experiences presented show that community organisations play a central role not only in prevention, but also in access to rights, mental health and social stability.

Finally, the speakers emphasised the need to defend these approaches politically in an international context of budget cuts and the rise of conservative anti-trans rhetoric, which has not spared Switzerland.

For attacks targeting trans identities never concern trans people alone. They often constitute a first step in the broader challenge to the rights of marginalised groups.

“Nothing about us without us”

Throughout the presentations, one idea kept recurring: trans people must not be viewed solely as “vulnerable groups targeted by prevention strategies”, but as key actors in the health policies that affect them.

Participatory research, community governance, expertise drawn from lived experience: the most effective projects are those built “by, for and with” trans communities.

Beyond the scientific data, AFRAVIH 2026 will thus have served as a reminder of an often-forgotten truth: HIV prevention works best when those affected have the power to take control of their own health.