Medical Mistrust and PrEP Perceptions Among Transgender Women: A Cluster Analysis

Abstract

Transgender (trans) women experience unique barriers in accessing preventative health services such as HIV preexposure prophylaxis (PrEP). These barriers may be exacerbated by past real or anticipated mistreatment in health care settings, but little is known about the relationship between medical mistrust and poor PrEP uptake and knowledge. Using a multistep approach, this study used a novel survey instrument administered to a pilot sample of 78 trans women. Item responses on a 0–10 scale were subjected to a TwoStep cluster analysis to explore how perceptions of PrEP and experiences with health care vary among trans women. Two distinct clusters (C1,C2) were defined on the basis of race (C1: 82% White, C2: 69% Black) and highest level of education completed (C1: 53% college or above, C2: 42% high school diploma or GED). Analyses suggest that varying levels of medical mistrust exist between clusters. Higher mean scores on medical mistrust items were reported in C1. A similar relationship was found on attitudes toward PrEP. Differences in intention to use PrEP and differences in past PrEP use were not significant; however, C2 members were more likely to have heard of PrEP from a doctor. Results suggest that levels of medical mistrust and PrEP perceptions vary among distinct subpopulations in this community, which may affect willingness to use PrEP. Interventions aimed at addressing unique perceptions in subpopulations could move trans women from intention to PrEP use.

The wisdom of mistrust: qualitative insights from transgender women who participated in PrEP research in Lima, Peru

“…Community-level recognition of the sheer volume of HIV prevention studies targeting trans women underscores the discordance between increases in PrEP research targeting trans women and limited improvements in HIV outcomes in the same population. Aligning with research from the United States [30]. our findings demonstrate how this tension fosters research mistrust at different points across the research continuum; from formative research to trial enrolment, refusal and loss to follow-up.…”

Acesso a PrEP por homens cisgênero e transexuais: Um estudo de abordagem qualitativa

“…Em relação às populações sob maior risco de infecção pelo HIV no Brasil, estudos brasileiros recentes de abrangência nacional, utilizando a metodologia Respondent-Driven Sampling (RDS), que apresentam prevalências de HIV, sífilis e hepatites B e C, HSH (Brasil, 2019;Couto, Paiva, Oliveira, Gomes, Rodrigues, & Teixeira, 2020) travestis e transgênero, e profissionais do sexo feminino, demonstram que em mulheres transexuais existe um risco em até 49 vezes maior de adquirir o HIV, se comparado com adultos da mesma faixa etária, que pertencem a população em geral (D'Avanzo, 2020) . Segundo o Programa das Nações Unidas para a Aids (UNAIDS), as mulheres transgêneras estão entre as populações mais afetadas pelo HIV.…”

HIV in Specific Populations

“…Barriers to PrEP access for trans people are multifactorial and still understudied as most data from this trans persons remains at survey level. Medical mistrust including actual and perceived transphobia in healthcare settings plays a significant factor in trans people accessing HIV prevention care [105], as do psychosocial factors such as lack of access to health insurance and homelessness. Prioritization of accessing hormone treatment over HIV prevention may also be a factor [105,106].…”

“…Medical mistrust including actual and perceived transphobia in healthcare settings plays a significant factor in trans people accessing HIV prevention care [105], as do psychosocial factors such as lack of access to health insurance and homelessness. Prioritization of accessing hormone treatment over HIV prevention may also be a factor [105,106]. Lack of information on PrEP specifically for trans woman and healthcare providers not offering or being not knowledgeable about PrEP is another major barrier, particularly for younger trans women who appear more knowledgeable about PrEP than their older trans women [105][106][107].…”