Barriers and Facilitators to PrEP Initiation and Adherence Among Transgender and Gender Non-Binary Individuals in Southern California

Overview

Journal AIDS Educ Prev

Specialties Infectious Diseases
Medical Education

Date 2021 Mar 29

PMID 33779208

Citations 14

Authors

C Wei-Ming Watson

Elizabeth Pasipanodya

Micah J Savin

Eric E Ellorin

Katya C Corado

Risa P Flynn

Chloe Opalo

Elizabeth Lampley

Brook L Henry

Jill Blumenthal

Robert Bolan

Sheldon Morris

David J Moore

Affiliations

Soon will be listed here.

Abstract

While transgender and gender non-binary (trans/nb) individuals are disproportionately affected by HIV, pre-exposure prophylaxis (PrEP) uptake remains low in this underserved population. We conducted four focus groups with 37 trans/nb individuals in San Diego and Los Angeles to assess barriers and facilitators of PrEP usage. Transcripts were coded for qualitative themes. Although overall PrEP awareness was high, participants reported limited knowledge and misinformation about PrEP. Barriers to PrEP use included: structural access (e.g., discrimination from health care providers, lack of trans-inclusive services, financial barriers), mental health struggles limiting ability to access PrEP, and concerns about potential side effects, drug-drug interactions with hormone therapy, and lack of other STI protection. Facilitators of PrEP usage included: increased PrEP availability, prior experience taking daily medications, and motivation to have active and healthy lives without fear of contracting HIV. Addressing both structural and psychosocial/behavioral factors in trans-affirming health care environments is crucial to designing inclusive, effective PrEP interventions.

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References

Feldman J, Swinburne Romine R, Bockting W . HIV risk behaviors in the U.S. transgender population: prevalence and predictors in a large internet sample. J Homosex. 2014; 61(11):1558-88. PMC: 4162812. DOI: 10.1080/00918369.2014.944048. View

Sales J, Swartzendruber A, Phillips A . Trauma-Informed HIV Prevention and Treatment. Curr HIV/AIDS Rep. 2016; 13(6):374-382. PMC: 5107145. DOI: 10.1007/s11904-016-0337-5. View

Williams M, Bowen A, Horvath K . The social/sexual environment of gay men residing in a rural frontier state: implications for the development of HIV prevention programs. J Rural Health. 2005; 21(1):48-55. PMC: 2614671. DOI: 10.1111/j.1748-0361.2005.tb00061.x. View

Poteat T, Malik M, Scheim A, Elliott A . HIV Prevention Among Transgender Populations: Knowledge Gaps and Evidence for Action. Curr HIV/AIDS Rep. 2017; 14(4):141-152. PMC: 5896563. DOI: 10.1007/s11904-017-0360-1. View

Kaufman M, Cornish F, Zimmerman R, Johnson B . Health behavior change models for HIV prevention and AIDS care: practical recommendations for a multi-level approach. J Acquir Immune Defic Syndr. 2014; 66 Suppl 3:S250-8. PMC: 4536982. DOI: 10.1097/QAI.0000000000000236. View

Sanchez T, Finlayson T, Murrill C, Guilin V, Dean L . Risk behaviors and psychosocial stressors in the new york city house ball community: a comparison of men and transgender women who have sex with men. AIDS Behav. 2009; 14(2):351-8. DOI: 10.1007/s10461-009-9610-6. View

Rael C, Martinez M, Giguere R, Bockting W, MacCrate C, Mellman W . Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City. AIDS Behav. 2018; 22(11):3627-3636. PMC: 6160363. DOI: 10.1007/s10461-018-2102-9. View

Valdiserri R, Holtgrave D . Ending HIV in America: Not Without the Power of Community. AIDS Behav. 2019; 23(11):2899-2903. DOI: 10.1007/s10461-019-02496-7. View

Sevelius J, Keatley J, Calma N, Arnold E . 'I am not a man': Trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health. 2016; 11(7-8):1060-75. PMC: 10204128. DOI: 10.1080/17441692.2016.1154085. View

10.

Smith D, Van Handel M, Wolitski R, Stryker J, Hall H, Prejean J . Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition--United States, 2015. MMWR Morb Mortal Wkly Rep. 2015; 64(46):1291-5. DOI: 10.15585/mmwr.mm6446a4. View

11.

Sevelius J, Deutsch M, Grant R . The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices. J Int AIDS Soc. 2016; 19(7(Suppl 6)):21105. PMC: 5071750. DOI: 10.7448/IAS.19.7.21105. View

12.

Wood S, Lee S, Barg F, Castillo M, Dowshen N . Young Transgender Women's Attitudes Toward HIV Pre-exposure Prophylaxis. J Adolesc Health. 2017; 60(5):549-555. PMC: 5401785. DOI: 10.1016/j.jadohealth.2016.12.004. View

13.

Klein A, Golub S . Increasing Access to Pre-Exposure Prophylaxis Among Transgender Women and Transfeminine Nonbinary Individuals. AIDS Patient Care STDS. 2019; 33(6):262-269. DOI: 10.1089/apc.2019.0049. View

14.

Grant R, Lama J, Anderson P, McMahan V, Liu A, Vargas L . Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010; 363(27):2587-99. PMC: 3079639. DOI: 10.1056/NEJMoa1011205. View

15.

Wilson E, Santos G, Raymond H . Sexual mixing and the risk environment of sexually active transgender women: data from a respondent-driven sampling study of HIV risk among transwomen in San Francisco, 2010. BMC Infect Dis. 2014; 14:430. PMC: 4132923. DOI: 10.1186/1471-2334-14-430. View

16.

Fauci A, Redfield R, Sigounas G, Weahkee M, Giroir B . Ending the HIV Epidemic: A Plan for the United States. JAMA. 2019; 321(9):844-845. DOI: 10.1001/jama.2019.1343. View

17.

Martinez O, Wu E, Levine E, Munoz-Laboy M, Fernandez M, Bauerle Bass S . Integration of Social, Cultural, and Biomedical Strategies into an Existing Couple-Based Behavioral HIV/STI Prevention Intervention: Voices of Latino Male Couples. PLoS One. 2016; 11(3):e0152361. PMC: 4814093. DOI: 10.1371/journal.pone.0152361. View

18.

Poteat T, Reisner S, Radix A . HIV epidemics among transgender women. Curr Opin HIV AIDS. 2013; 9(2):168-73. PMC: 5947322. DOI: 10.1097/COH.0000000000000030. View

19.

Hojilla J, Koester K, Cohen S, Buchbinder S, Ladzekpo D, Matheson T . Sexual Behavior, Risk Compensation, and HIV Prevention Strategies Among Participants in the San Francisco PrEP Demonstration Project: A Qualitative Analysis of Counseling Notes. AIDS Behav. 2015; 20(7):1461-9. PMC: 4592687. DOI: 10.1007/s10461-015-1055-5. View

20.

Wilson E, Jin H, Liu A, Raymond H . Knowledge, Indications and Willingness to Take Pre-Exposure Prophylaxis among Transwomen in San Francisco, 2013. PLoS One. 2015; 10(6):e0128971. PMC: 4454556. DOI: 10.1371/journal.pone.0128971. View