Abstract
PurposeDisparities persist in HIV infection among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW). Increasing uptake and subsequent consistent use of pre-exposure prophylaxis (PrEP), an effective biomedical strategy for preventing HIV acquisition, can dramatically reduce HIV incidence in these populations. The purpose of this study was to explore reasons for PrEP discontinuation among BLMSM and BLTW living in Los Angeles County to inform the development of support services for these populations to remain persistent with their PrEP regimen.MethodsIn-depth, semi-structured interviews were conducted with 15 BLMSM and 7 BLTW who reported either temporary or indefinite PrEP discontinuation. A thematic analysis approach was used to analyze qualitative data.ResultsFour themes emerged related to reasons for PrEP discontinuation, including: (1) lower perceived HIV risk related to changes in sexual behavior; (2) structural or logistical barriers (e.g., lapse or loss of health insurance, cost, difficulty navigating complex medical systems); (3) anticipated and experienced medication side effects, with a sub-theme of interactions between PrEP and feminizing hormone medications; and (4) challenges with medication adherence.ConclusionsPrEP is an important prevention tool for BLMSM and BLTW, particularly during periods of heightened HIV risk. However, both individual (e.g., inability to adhere to medication, changes in HIV sexual risk behaviors) and structural/logistical (e.g., loss of insurance, navigating complex medical systems) factors can cause temporary or indefinite PrEP discontinuation. Additional support services, beyond those offered by medical providers, are needed to help BLMSM and BLTW PrEP users overcome barriers to discontinuation and assist them to remain persistent with their PrEP regimen. We describe potential options for support services such as PrEP case management, expanded PrEP navigation services, or text messaging services.
Highlights
HIV disparities persist among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW)
Pre-Exposure Prophylaxis (PrEP) is an important prevention tool for BLMSM and BLTW, during periods of heightened HIV risk. Both individual and structural/logistical factors can cause temporary or indefinite PrEP discontinuation
Additional support services, beyond those offered by medical providers, are needed to help BLMSM and BLTW PrEP users overcome barriers to discontinuation and assist them to remain persistent with their PrEP regimen
Summary
HIV disparities persist among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW). The Centers for Disease Control and Prevention (CDC) estimates that one in two Black MSM and one in five Latino MSM will be infected with HIV in their lifetime, compared with one in eleven white MSM [1]. According to the CDC, of all HIV diagnoses among transgender women (TW) from 2009 to 2014, 51% were Black TW, 29% were Latina TW, and only 11% were among white TW [3] These alarming trends signal an urgent need to increase the uptake and continued use of effective prevention strategies, such as Pre-Exposure Prophylaxis (PrEP), among high-risk persons living at the intersections of racial, ethnic, sexual, and gender-diverse identities
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