Attitudes, Beliefs, and Barriers to PrEP Among Trans Men

Rowniak, Stefan; Ong-Flaherty, Chenit; Selix, Nancy; Kowell, Niko

doi:10.1521/aeap.2017.29.4.302

Cited by 44 publications

(40 citation statements)

References 17 publications

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“…Trans MSM who could be potential candidates for PrEP care, or behavioural HIV risk reduction generally, are likely being overlooked by medical providers due to the gap in research. To the best of our knowledge, only one small qualitative PrEP study of trans men has been published in the peer‐reviewed literature to date . This study found low levels of information about PrEP among trans men sampled and barriers to PrEP access, including financial costs.…”

Section: Introductionmentioning

confidence: 85%

“…Experiencing stigma from cis male sex partners may activate socialization and stress pathways around gender norms and HIV risk for trans MSM . For example, trans MSM may feel pressure from cis male sex partners to engage in risky sexual behaviours prioritizing validation of their gender identity as men . Studies are needed to identify the specific vulnerabilities facing trans MSM for future interventional research, including PrEP service delivery.…”

Section: Introductionmentioning

confidence: 99%

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High risk and low uptake of pre‐exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States

et al. 2019

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Introduction Trans masculine people who have sex with cisgender (“cis”) men (“trans MSM”) may be at‐risk for HIV infection when they have cis MSM partners or share needles for hormone or recreational drug injection. Limited data are available characterizing indications and uptake of pre‐exposure prophylaxis (PrEP) in trans MSM. The aim of this study was to assess PrEP indication and uptake as a means of primary HIV prevention for adult trans MSM in the U.S. Methods Between November and December 2017, a national convenience sample of trans MSM in the U.S. (n = 857) was recruited using participatory methodologies and completed an online survey of demographics, HIV risk, PrEP, behavioural and psychosocial factors. Self‐reported receptive anal sex or frontal/vaginal sex (with or without a condom) with a cis male sex partner in past six months was an eligibility criterion. A multivariable logistic regression procedure was used to model PrEP indications (yes/no) per an interpretation of U.S. Centers of Disease Control and Prevention recommendations among those without HIV (n = 843). Results The diverse sample was 4.9% Black; 22.1% Latinx ethnicity; 28.4% non‐binary gender identity; 32.6% gay‐identified; 82.7% on testosterone. Overall, 84.1% had heard of PrEP. Of these, 33.3% reported lifetime PrEP use (21.8% current and 11.5% past). Based on HIV behavioural risk profiles in the last six months, 55.2% of respondents had indications for PrEP. In a multivariable model, factors associated with PrEP indication included where met sex partners, not having sex exclusively with cismen, higher perceived HIV risk, greater number of partners and high cis male partner stigma (all p < 0.05). Discussion The majority of trans MSM in this sample had a PrEP indication. Stigma was associated with risk for HIV acquisition and represents a critical target for HIV biobehavioural prevention interventions for trans MSM, who appear to be underutilizing PrEP. Conclusions Results from this study support the full inclusion of trans MSM in HIV biobehavioural prevention efforts. Public health interventions and programmes are needed to reach trans MSM that attend to general MSM risk factors as well as to vulnerabilities specific to trans MSM, including the context of stigma from cis male sexual partners.

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Section: Introductionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

High risk and low uptake of pre‐exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States

et al. 2019

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“…Safety concerns were also reported in a large study at a New York City health center focusing on sexual and general health for LGBTQ communities; of 1208 PrEP users, 783 reported barriers; 67 reported side effects as a barrier to PrEP use, nine of whom stopped taking PrEP [20]. In addition, transgender individuals have specific concerns regarding PrEP and interactions with hormonal treatment [50,[89][90][91]. Finally, although there are no data in the literature to quantify the actual impact on PrEP uptake, anecdotally there are concerns that misleading lawyer advertisements about lawsuits concerning F/TDF in the USA may play into patients' concerns around PrEP side effects, leading them to discontinue or refuse PrEP medication [92].…”

Section: Side Effects/medication Interaction Concerns As a Barrier Tomentioning

confidence: 99%

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

2020

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Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.

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“…42 Barriers among transgender men include possible side effects, cost issues, identifying trans-competent providers, importance of contraception, and condom use. 43 Regarding cost, the list price of daily emtricitabine-tenofovir is nearly $2,000 per month. 44 Many insurance plans help cover costs, although deductibles and co-pays can hinder access to PrEP.…”

Section: Prep Uptakementioning

confidence: 99%

Preexposure Prophylaxis for Human Immunodeficiency Virus Infection for Men Who Have Sex with Men and Transgender Persons:

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Park

Marcus

2020

Dermatologic Clinics

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Attitudes, Beliefs, and Barriers to PrEP Among Trans Men

Cited by 44 publications

References 17 publications

High risk and low uptake of pre‐exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States

High risk and low uptake of pre‐exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

Preexposure Prophylaxis for Human Immunodeficiency Virus Infection for Men Who Have Sex with Men and Transgender Persons:

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