Disparities and Inequity in Access to HIV Pre‐Exposure Prophylaxis for Cisgender and Transgender Women: A Global Perspective Across WHO Regions

Over a decade since its introduction, pre‐exposure prophylaxis (PrEP) has significantly expanded the HIV prevention toolkit. However, although more than 3.5 million people received PrEP globally in 2023, this remains well below the global target of 10 million users by 2025, and global implementation reveals persistent disparities, particularly affecting women, including both cisgender women (CW) and transgender women (TW). Despite World Health Organization (WHO)‐endorsed recommendations, PrEP uptake among these populations remains disproportionately low across multiple regions, including sub‐Saharan Africa, the Americas, Southeast Asia, the Eastern Mediterranean, Europe, and the Western Pacific. This narrative review synthesizes regional patterns and identifies epidemiologic, legal, and structural factors that perpetuate both inequalities, quantifiable differences in access, and deeper inequities rooted in stigma, exclusion from health systems, and gender‐based vulnerability. Although many CW are formally eligible for PrEP, their uptake remains low due to low‐risk perception, limited outreach, and sociocultural constraints. TW may have higher levels of PrEP awareness in some contexts, yet continue to face layered structural barriers including criminalization, healthcare discrimination, and lack of gender‐affirming services. Across regions, surveillance often fails to disaggregate data by gender identity, clinical trials exclude female participants, and provider bias persists. However, promising models such as community‐led delivery in Thailand and South Africa, integrated sexually transmitted infection (STI) services in Cambodia, and long‐acting injectable PrEP, highlight pathways to more inclusive prevention. By framing access through the lens of inequity, this review emphasizes that improving coverage requires more than policy expansion: it demands tailored, context‐sensitive strategies that center the needs of the most underserved. Ensuring equitable PrEP access for all genders requires more than policy expansion: it demands coordinated efforts in data collection, health system reform, legal advocacy, and community‐led innovation.