PrEP Attitudes from MSM and Transwomen in the Largest Suburban HIV Epidemic in the USA

Abstract

Long Island has the largest suburban human immunodeficiency virus (HIV) epidemic in the USA with an estimated 5,730 people living with HIV/AIDS in 2018 (most recent data). While pre-exposure prophlaxis (PrEP) is a promising primary intervention strategy to reduce HIV incidence, the uptake of this biomedical prevention strategy has been very low. Factors such as homophobia, stigma, and discrimination against men who have sex with men (MSM) and transgender women still exist in the community through provider interactions, and negatively affect the well-being of these populations. The aim of this study was to examine PrEP knowledge, attitudes, and practices among MSM and transgender women on Long Island. Fifteen interviews were conducted with MSM and transgender women; interviews were transcribed and analyzed using an inductive method involving constant comparison. Four main themes emerged from our analysis: (1) participants have high agency in accessing and utilizing HIV-related biomedical prevention services; (2) participants had limited understanding of what PrEP is and what it means to be on PrEP; (3) PrEP-user stigma and costs are the biggest barriers to initiating and remaining on PrEP; and (4) E-health, credible Internet-resources, and technology-based programming are needed to support current and potential PrEP users. This study, the first study of PrEP attitudes in a suburban environment, highlights the need for evidence-based health promotion and sexual health interventions designed for suburban gender and sexual minorities that are evidence-based and go beyond goal setting and improving self-efficacy.