Abstract
Purpose: In Argentina, transgender women face a disproportionately high prevalence of HIV infection (34%). Although not currently approved in Argentina, pre-exposure prophylaxis (PrEP) may offer a potential effective HIV prevention tool for this population. In this study, we assessed the willingness to use PrEP among transgender women in Argentina.Methods: Data were drawn from a nationwide cross-sectional survey conducted among transgender women in 2013. Using multivariable logistic regression, we assessed the prevalence of and factors associated with willingness to use PrEP among transgender women with negative or unknown HIV status.Results: This study included 337 transgender women (278 HIV negative and 59 with unknown HIV status), most of whom had a history of sex work involvement (81.8%). Overall, 301 (89.3%) expressed willingness to use PrEP. In a multivariable analysis, having casual sexual partners was positively associated with willingness to use PrEP (adjusted odds ratio [AOR]=4.26, 95% confidence interval [CI] 1.73–10.51), while discrimination by healthcare workers was negatively associated (AOR=0.33, 95% CI 0.12–0.88).Conclusion: We found high levels of willingness to use PrEP among transgender women in Argentina, suggesting that there is high perception of HIV risk in this population. However, discrimination by healthcare workers was a strong negative correlate of willingness to use PrEP, suggesting that multilevel interventions that address gender-based stigma in healthcare settings will be critical for the success of PrEP as an HIV prevention strategy in this population.
Highlights
Transgender women continued to be disproportionately represented in the HIV epidemic, with an estimated overall prevalence of HIV infection of 19.1%.1 In Argentina, the burden of HIV infection among transgender women is high
Selfidentified transgender individuals were recruited through extensive outreach with a focus on sex work venues and community-based organizations known to be frequented by transgender persons
In the final model (Table 2), only having casual partners (AOR = 4.26, 95% CI 1.73–10.51) was positively associated with willingness to use Pre-exposure prophylaxis (PrEP), while discrimination by healthcare workers remained negatively associated with willingness to use PrEP (AOR = 0.33, 95% CI 1.12–0.88)
Summary
Transgender women continued to be disproportionately represented in the HIV epidemic, with an estimated overall prevalence of HIV infection of 19.1%.1 In Argentina, the burden of HIV infection among transgender women is high. Transgender women continued to be disproportionately represented in the HIV epidemic, with an estimated overall prevalence of HIV infection of 19.1%.1. In Argentina, the burden of HIV infection among transgender women is high. Estimated HIV prevalence and incidence rates are 34% (compared with 0.4% in the general population) and 11 per 100 person-years, respectively.[2,3] Widespread discrimination[4,5,6] combined with high levels of behavioral risk factors, such as condomless sexual exposure, sex work, substance use,[7,8,9] and other psychosocial and structural vulnerabilities, creates multiple barriers to healthcare access that contribute to transgender women’s disproportionate burden of HIV infection as well as other health problems.[10,11].
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