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

Abstract

Background Trans 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. Methods This qualitative study conducted focus groups (n = 5) in Philadelphia and Sacramento with trans women to assess these issues. Results Twelve 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. Conclusions Without 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.

PrEP Uptake in North Carolina: Innovative Strategies for Reducing Barriers

“…Multilevel barriers to PrEP uptake exist for these communities. For example, it is well understood that many at-risk African American/Black and Latine GBMSM and transgender women are not aware of PrEP, lack correct information about PrEP, and do not think about PrEP as a personally viable option [7][8][9][10][11][12][13][14][15]. We also know that overall, many GBMSM and transgender women hold profound misconceptions about PrEP and its efficacy, side effects, and safety, and these misconceptions tend to be magnified among African American/Black and Latine persons [7].…”

“…We also know that overall, many GBMSM and transgender women hold profound misconceptions about PrEP and its efficacy, side effects, and safety, and these misconceptions tend to be magnified among African American/Black and Latine persons [7]. Many transgender women also worry about potential interactions with transition-related medications [6,[8][9][10]. Even if they want to pursue obtaining PrEP, African American/ Black and Latine GBMSM and transgender women often lack knowledge of: providers who prescribe PrEP, the process for accessing PrEP, the cost and different ways to pay for PrEP (especially if uninsured), and eligibility requirements (and documents needed) to access available services and financial assistance (e.g., PrEP access programs and sliding-scale payment plans) [7][8][9][10][11].…”

“…Many transgender women also worry about potential interactions with transition-related medications [6,[8][9][10]. Even if they want to pursue obtaining PrEP, African American/ Black and Latine GBMSM and transgender women often lack knowledge of: providers who prescribe PrEP, the process for accessing PrEP, the cost and different ways to pay for PrEP (especially if uninsured), and eligibility requirements (and documents needed) to access available services and financial assistance (e.g., PrEP access programs and sliding-scale payment plans) [7][8][9][10][11]. Some GBMSM and transgender women who do not speak English are unaware of interpretation services at clinics and assume that they will be unable to get their questions answered and needs met.…”

“…They may lack skills for communicating effectively with providers; worry about being subjected to discrimination based on being African American/Black, Latine, GBMSM, transgender, and/or an immigrant (or perceived to be an immigrant); and anticipate that clinic staff will not be culturally competent. They may be concerned about the threat of immigration enforcement, have transportation challenges, and lack self-efficacy to overcome these complex and multilevel barriers to PrEP uptake [7][8][9][10][11][12][13][14][15]. Other psychosocial barriers that also may inhibit PrEP use and adherence include stigma related to sexual orientation and gender identity and/or related to PrEP use, homo-negativity, trans-negativity, and fatalism [6,7].…”

‘We go where we know’: Reflections from Mobilizing for PrEP and Sexual Health (MobPrESH) – A peer-led PrEP education programme across England, for and by women and non-binary people

“…Also in the United States, trans women voiced concerns about how PrEP would affect hormone use and called for culturally appropriate messaging specific to trans communities. 16 …”