Exploring barriers and facilitators to PrEP use among transgender women in two urban areas: implications for messaging and communication

Sarah Bauerle Bass,Jae Sevelius,Kimberly Koester,Jesse Brajuha,Luis Gutierrez-Mock,Patrick J Kelly,Paul D’Avanzo

doi:10.1186/s12889-021-12425-w

Sarah Bauerle Bass, Jae Sevelius + Show 5 more

Open Access

https://doi.org/10.1186/s12889-021-12425-w

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Abstract

BackgroundTrans women are at increased risk for HIV infection yet are less likely to use pre-exposure prophylaxis (PrEP) medication as a preventive measure. PrEP messaging and marketing has focused on men who have sex with men (MSM) or included trans women as a subset of MSM, ignoring the potential barriers to PrEP use unique to trans women. Little is known about how this group conceptualizes PrEP, what knowledge gaps still exist, and how trans women believe PrEP should be communicated to increase use.MethodsThis qualitative study conducted focus groups (n = 5) in Philadelphia and Sacramento with trans women to assess these issues.ResultsTwelve sub-themes were found related to five main domains, including PrEP knowledge, benefits, barriers, community-related considerations, and messaging/marketing. Findings indicate that knowledge of PrEP is still low and beliefs about PrEP’s effects on hormone use persist. Most importantly, participants voiced a demand for culturally appropriate trans-specific messages in HIV prevention interventions and communication.ConclusionsWithout acknowledging specific barriers to PrEP uptake among transgender women separate from those of MSM and incorporating gender affirmation into PrEP education, simply knowing PrEP is available may not motivate trans women to use PrEP. This has important implications for future efforts to communicate about PrEP with trans women.

Highlights

Trans women are at increased risk for human immunodeficiency virus (HIV) infection yet are less likely to use pre-exposure prophylaxis (PrEP) medication as a preventive measure
Demographic characteristics Focus groups ranged in size from 3 to 10 participants
Demographics were similar by site, the mean age in Philadelphia (46) was higher than Sacramento (34)

Summary

Introduction

Trans women are at increased risk for HIV infection yet are less likely to use pre-exposure prophylaxis (PrEP) medication as a preventive measure. In the United States transgender women (trans women) are 34 times more likely to be living with human immunodeficiency virus (HIV) than the general population and HIV prevalence among trans women is estimated to be 14% [1, 2]. HIV rates among trans women are likely underestimated because the majority of U.S HIV reporting districts do not systematically capture trans identities when collecting HIV surveillance information [3]. Data from the National HIV Surveillance System found that of the 2351 trans individuals who were newly diagnosed with HIV from 2009 to 2014, 84% were trans women [4]. A recent prevalence study in seven US cities indicated that 51.2% of trans women in Philadelphia and 41.2% in San Francisco, the areas where this study occurred, were living with HIV [8]

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