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We used epidemic modelling to investigate these intersecting health harms among MSM\/TW in Lima, Peru and assess whether they could be mitigated by prioritizing HIV pre\u2010exposure prophylaxis (PrEP) and harm reduction interventions among MSM\/TW who use stimulants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We adapted a dynamic model of HIV transmission among MSM\/TW in Lima to incorporate stimulant use and increased HIV risk, suicide and CVD mortality. Among 6% to 24% of MSM\/TW using stimulants (mostly cocaine), we modelled an increased risk of unprotected anal sex (RR\u00a0=\u00a01.35 [95%CI: 1.17 to 1.57]) obtained from local data, and increased risk of suicide (SMR\u00a0=\u00a06.26 [95%CI: 2.84 to 13.80]) and CVD (SMR\u00a0=\u00a01.83 [95%CI: 0.39 to 8.57]) mortality associated with cocaine use based on a global systematic review. We estimated the proportion of health harms occurring among MSM\/TW who use stimulants in the next year (01\u20102020\/01\u20102021). We also investigated the 10\u2010year impact (01\u20102020\/01\u20102030) of: (1) PrEP prioritization for stimulant\u2010using MSM\/TW compared to random allocation, and (2) integrating PrEP with a theoretical intervention halving stimulant\u2010associated risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>MSM\/TW in Lima will experience high HIV incidence, suicide mortality and CVD mortality (1.6\/100\u00a0py, and 0.018\/100\u00a0py, 0.13\/100\u00a0py respectively) in 2020. Despite stimulant using MSM\/TW comprising an estimated 9.5% (95%CI: 7.8 to 11.5) of all MSM\/TW, in the next year, 11% 95%CI (i.e. 2.5% to 97.5% percentile) 10% to 13%) of new HIV infections, 39% (95%CI: 18% to 60%) of suicides and 15% (95%CI: 3% to 44%) of CVD deaths could occur among this group. Scaling up PrEP among all stimulant using MSM\/TW could prevent 19% (95%CI: 11% to 31%) more HIV infections over 10\u00a0years compared to random allocation. Integrating PrEP and an intervention to halve stimulant\u2010associated risks could reduce new HIV infections by 20% (95%CI: 10% to 37%), suicide deaths by 14% (95%CI: 5% to 27%) and CVD deaths by 3% (95%CI: 0% to 16%) over a decade.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MSM\/TW who use stimulants experience a disproportionate burden of health harms. Prioritizing PrEP based on stimulant use, in addition to sexual behaviour\/gender identity criteria, could increase its impact. Integrated substance use, harm reduction, mental health and HIV care among MSM\/TW is needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25495","type":"journal-article","created":{"date-parts":[[2020,6,20]],"date-time":"2020-06-20T05:32:14Z","timestamp":1592631134000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Integrating HIV pre\u2010exposure prophylaxis and harm reduction among men who have sex with men and transgender women to address intersecting harms associated with stimulant use: a modelling study"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6033-9837","authenticated-orcid":false,"given":"Annick","family":"B\u00f3rquez","sequence":"first","affiliation":[{"name":"Department of Medicine University of California San Diego La Jolla CA USA"},{"name":"National Drug and Alcohol Research Center University of New South Wales Sydney NSW 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