Barriers and facilitators for optimizing HIV screening target trans women in Taiwan: convergent mixed-method design

Abstract

Background Trans women are a key global population affected by HIV infection. Although strategies have targeted to encourage trans women to complete HIV screening, frequency of testing in this population remains low. Purpose To reveal barriers and facilitators for a tailored HIV testing model targeting trans women. Methods A convergent mixed-method was applied. Quantitative data were collected via convenience sampling through online questionnaires, and qualitative data were collected via quota sampling through semi-structured interviews. Results In total, 213 participants were recruited with a mean age of 28.7 (SD = 7.57). A high percentage (67.1%, 143/213) of participants had never undergone HIV testing. They were more likely to have no monthly income, have been diagnosed or be experiencing gender dysphoria, have had condomless sex, and have current sexual partners with vaginal genital structure; many had never heard of HIV preventive medications. Integrated results showed that the barriers to accessing HIV testing included underestimated HIV risk, inadequate capacity of testing and results, insufficient access to preventive information within transgender community, and lack of dedicated screening resources. Facilitators included: delivering trustworthy messages through valuable channels and motivating companions through significant others, promoting the screener’s competency of transgender culture; the screener’s service experience should be available, and HIV testing options should be available via gender affirmation therapy. Conclusion The mixed-method analysis promotes the clarification of previously unknown experiences that impede and facilitate trans women’s access to HIV testing. This result could be applied to optimize the current HIV testing model to target trans women.