“It’s behaviors, not identity”: Attitudes and beliefs related to HIV risk and pre-exposure prophylaxis among transgender women in the Southeastern United States

Abstract

HIV prevalence is high among transgender women (TGW) in the Southeastern U.S. Uptake of HIV Pre-Exposure Prophylaxis (PrEP) is low among TGW nationwide. We aimed to explore beliefs associated with PrEP among TGW in the Southeastern U.S., framed by the Health Belief Model. HIV-negative TGW ≥18 years old in Alabama participated in virtual focus group discussions. Authors coded and amended transcripts to explore emerging themes. Between July-December 2020, 17 TGW participated in 4 sessions. Mean age was 28.1±8.5 years. Several themes were identified: frustration with conflation of transgender identity and HIV risk, inappropriate transgender representation in PrEP advertising, concerns for interactions between PrEP and hormone therapy, perception that PrEP is meant for cisgender men who have sex with men and limited trans-affirming healthcare. Nuanced messaging is necessary to properly educate and engage TGW in HIV prevention strategies including PrEP given the diversity of this population.

Sexual healthcare and at-home STI test collection: attitudes and preferences of transgender women in the Southeastern United States

“…This study augments previous work done by our team exploring the preferences of transgender women in Alabama regarding how they receive sexual healthcare ( 4 ). In the wake of the COVID-19 pandemic, telehealth and at-home healthcare technologies are now a permanent fixture in care delivery, both in the US and worldwide ( 18 ).…”

“…Despite this immense disease burden, uptake of effective HIV prevention strategies such as Pre-Exposure Prophylaxis (PrEP) remain low in this population, especially in the Southeastern US ( 3 ). Reasons for this are multifactoral, including limited access to gender-affirming healthcare providers and services, intersecting stigma associated with PrEP and transgender identity, and concern for drug-drug interactions between PrEP and hormone replacement therapy ( 4 , 5 ). Furthermore, the Southeastern US accounts for the most of the new HIV infections annually and is home to a growing population of transgender individuals ( 6 ).…”

“…As such, transgender women may have unique preferences related to STI screening/testing in this setting. In a pilot study previously conducted by our team ( 4 ), transgender women in the Southeastern US identified STIs to be a major concern in their communities. In the current qualitative study, we explored community-specific considerations among transgender women living in Alabama regarding receipt of sexual healthcare services including STI screening/testing in general and as a part of HIV PrEP care.…”

Health and service utilization among a sample of gender-diverse youth of color: the TRUTH study

“…Moreover, PrEP messaging is often geared towards cisgender men who have sex with men. Transgender people may have concerns about interactions between PrEP and hormone regimens, and concerns about the conflation of TGD identitiy with HIV risk instead of a behavior based risk assessment [ 66 , 67 ]. In additon to structural barriers, these factors may contribute to the low uptake in TGD communities as seen in this sample [ 66 , 67 ].…”

“…Transgender people may have concerns about interactions between PrEP and hormone regimens, and concerns about the conflation of TGD identitiy with HIV risk instead of a behavior based risk assessment [ 66 , 67 ]. In additon to structural barriers, these factors may contribute to the low uptake in TGD communities as seen in this sample [ 66 , 67 ]. These findings and the current state of sexual health education underscore a clear indication for HIV prevention efforts targeting a variety of sexual health behaviors, and mechanisms of risk associated with the intersection of gender and sexual anatomy.…”