Young Transgender Women's Attitudes Toward HIV Pre-exposure Prophylaxis

Abstract

Purpose Our primary aim was to explore themes regarding attitudes toward HIV pre-exposure prophylaxis (PrEP) among young transgender women (YTW), in order to develop a theoretical model of PrEP uptake in this population disproportionally affected by HIV. Methods Qualitative study nested within a mixed-method study characterizing barriers and facilitators to health services for YTW. Participants completed an in-depth interview exploring awareness of and attitudes toward PrEP. Key themes were identified using a grounded theory approach. Results Participants (n=25) had a mean age of 21.2 years (SD 2.2, range 17–24), and were predominately multi-racial (36%) and of HIV-negative or unknown status (68%). Most participants (64%) reported prior knowledge of PrEP, and 28% reported current use or intent to use PrEP. Three major content themes that emerged were variability of PrEP awareness, barriers and facilitators to PrEP uptake, and emotional benefits of PrEP. Among participants without prior PrEP knowledge, participants reported frustration that PrEP information has not been widely disseminated to YTW, particularly by healthcare providers. Attitudes toward PrEP were overwhelmingly positive, however concerns were raised regarding barriers including cost, stigma, and adherence challenges. Both HIV-positive and negative participants discussed emotional and relationship benefits of PrEP, which were felt to extend beyond HIV prevention alone. Conclusions A high proportion of YTW in this study had prior knowledge of PrEP, and attitudes toward PrEP were positive among participants. Our findings suggest several domains to be further explored in PrEP implementation research, including methods of facilitating PrEP dissemination and emotional motivation for PrEP uptake.

Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City

“…Interestingly, all but one respondent in our focus groups had heard of oral PrEP prior to participating in this study. This is contrary to other work, which found that “lack of knowledge” about PrEP is a barrier to uptake in transgender women (7, 42). Thus, our findings may mean that in NYC, ad campaigns are successful in communicating the existence of PrEP, but fail to convince transgender women that this product is appropriate for them.…”

“…In contrast to findings from other work (15, 42, 44), the cost of oral PrEP and “access to PrEP” were not identified as barriers to product use in our study. This could be because most focus group participants were covered by public or private health insurance, and likely felt that PrEP would be included in their prescription benefit.…”

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“…Transgender women (TW) are a medically underserved and largely understudied population who often experience barriers to care. [1][2][3][4][5][6][7][8][9][10] This population experiences high rates of stigma, violence, and an inability to receive even the most basic health care; this is particularly true with the subpopulation of TW of color (TWC) (African American, Native American, Latina, and/or Asian Pacific Islander). 11 TWC are among those most highly affected by human immunodeficiency virus (HIV), recent and past trauma and violence, stigma, discrimination, and other barriers to primary and specialty care.…”

“…11 TWC are among those most highly affected by human immunodeficiency virus (HIV), recent and past trauma and violence, stigma, discrimination, and other barriers to primary and specialty care. [12][13][14] The need for credible, sensitive, and comprehensive health care for TWC has been identified in numerous studies, [1][2][3][4][5][6][7][8][9][10][11][12][13][14] yet unfortunately, lack of access to care and culturally competent clinicians continue to serve as structural barriers to health-related services.…”

“…Recent needs assessment data 16 reveal that TWC in District of Columbia reflect the numerous challenges to health and health care receipt shown in other studies. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Novel ways to improve access to care among TWC are urgently needed. Telehealth interventions offer new approaches that may be able to provide TWC with care that can overcome the barriers they often experience, yet this approach has been previously unexamined among this population.…”