Experiences of Pre-Exposure Prophylaxis Stigma, Social Support, and Information Dissemination Among Black and Latina Transgender Women Who Are Using Pre-Exposure Prophylaxis

Abstract

In the United States, HIV disproportionally affects Black and Latina transgender women (BLTW). Preexposure prophylaxis (PrEP) is a proven biomedical method for preventing HIV acquisition. However, the social stigma attached to using PrEP may deter uptake and persistence of PrEP among BLTW, two highly vulnerable populations. The purpose of this study was to explore the experiences of PrEP stigma among BLTW who are using PrEP in Los Angeles County. Methods: In-depth, semistructured interviews were conducted with BLTW PrEP users (N = 19) to explore experiences of anticipated, enacted, and internalized PrEP stigma within the context of their unique social and contextual factors. A thematic analysis approach was used in the analysis of qualitative data. Results: We noted an underlying theme of HIV stigma related to participants' identification as trans women that served as the social context for other experiences. In addition, our data revealed five themes related to the experience of using PrEP. Three themes were specifically related to PrEP stigma and included: (1) Perception that BLTW PrEP users are HIV-positive; (2) perception that BLTW PrEP users engage in elevated sexual risk behaviors; and (3) negative labels ascribed to BLTW PrEP users. A fourth theme identified was the positive experiences of social support after PrEP disclosure reported by BLTW. Our fifth theme identified involved the dissemination of PrEP information by BLTW to friends/peers and sex partners. Conclusion: BLTW experience PrEP stigma within the context of PrEP disclosure. This experience is underscored by existing experiences of HIV stigma connected to their identity as trans women. PrEP providers should prepare BLTW to use selective disclosure practices when revealing their PrEP use to help minimize experiences of PrEP stigma or potential physical harm. PrEP implementation programs should also support peer-to-peer PrEP education programs for transgender women to promote positive views of PrEP and help facilitate PrEP uptake in this population.

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

“…These findings align with other studies with racial/ethnic, sexual, and gender minorities [11,17,19,20]. As we consider ways to reduce HIV infections among highly impacted minority populations, it is important to address these structural barriers to PrEP continuation from a health equity perspective, as many of these factors are rooted in the social determinants of health experienced by these populations [21,22]. The establishment of universal health care coverage could greatly improve access and persistent use of PrEP among highly vulnerable populations.…”

“…We also identified PrEP advocacy as a supportive factor in the continued use of PrEP. Some BLMSM and BLTW who recognized the mental and physical health benefits of their PrEP use emerged as PrEP advocates and routinely provided information to peers about the importance of PrEP in preventing HIV infection, corrected misinformation, or challenged PrEP stigma when it occurred [19][20][21].…”

“…Between January 2017 and November 2018, a purposive sample of BLMSM and BLTW PrEP users was recruited to participate in in-depth qualitative interviews to explore their experiences of PrEP-related stigma (i.e., anticipated, enacted, internalized) [19][20][21]. Participants were recruited through gay-oriented sexual and social networking apps (i.e., Grindr and Growlr), a LGBTQ community agency or participant referral, and dissemination of study promotional materials at population-specific community events.…”

The influence of HIV‐related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study

“…Up to 25 participants were purposively recruited for qualitative interviews per study site. We hypothesized that this sample size would be adequate to achieve saturation of key themes based on qualitative work investigating similar issues of stigma and disclosure among new PrEP users . Participant selection was stratified into three groups at each site: those who accepted PrEP and adhered well by week 4, those who accepted PrEP but had difficulty adhering by week 4, and those who declined PrEP through the first 12 weeks of follow‐up.…”

The importance of PrEP persistence in preventing HIV infections on PrEP

“…We agree that stigma related to PrEP or sexual behaviour [2‐4] is an important factor that may interfere with PrEP persistence (consistent use of PrEP during periods with potential HIV exposure) [5]. Participants in this analysis did not report stigma related to being a man who has sex with men (MSM) as a factor in their PrEP gaps, but two participants discussed stigma related to the image of PrEP as a medication for people with multiple sexual partners, and at least one participant feared disclosure of her PrEP use to her partner as she felt it might imply she had outside partners [6].…”