PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

Abstract

Purpose Disparities 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. Methods In-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. Results Four 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. Conclusions PrEP 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.

Improved PrEP Awareness and Use among Trans Women in San Francisco, California

“…Previous research has found that significant racial/ethnic disparities exist in PrEP knowledge and use [26][27][28] particularly among Black/African Americans and the Latinx community and that these disparities are pronounced among trans women [20]. Black trans women made up 15% of the STAY study population, and, in this study, 11% of the participants who reported they were also a STAY study participant were Black (data not shown).…”

Correlates of PrEP Uptake Among Young Sexual Minority Men and Transgender Women in New York City: The Need to Reframe “Risk” Messaging and Normalize Preventative Health

“…Furthermore, this was a significant driver of current PrEP use for participants of color, but not for White participants, suggesting that PrEP education from healthcare providers may be particularly important to facilitating PrEP uptake for SMM and trans women of color, who face disproportionate burdens of HIV incidence and prevalence [5]. For providers treating trans women specifically, it is also important to be aware of the unique concerns this population may have, such as concerns related to hormone medications [63,73]. In this sense, providers must broadly be competent in many facets of LGBTQ health, and not only around SMM's needs.…”

The Influence of Family Bonding, Support, Engagement in Healthcare, on PrEP Stigma among Young Black and Latino Men Who Have Sex with Men: A Path Analysis

“…Although pre-exposure prophylaxis (PrEP) proves efficacious in reducing HIV transmission, not all populations benefit from the advancement equally [1,2]. Black and Latino men who have sex with men (BLMSM) have lower rates of access and uptake of PrEP compared with their white counterparts [3][4][5][6]. Among MSM qualifying for a PrEP prescription in 2019, Black and Latino men showed 8% and 14% prescription rates, respectively, compared with white men at 63% [7].…”

“…These factors are structural health care barriers, such as lack of access, insurance status, and discrimination/racism. Social factors emanating from homophobia, HIV stigma, and additional personal elements within the cultural/community context have also contributed to low PrEP use [5,6,[9][10][11]. Stigma continues to create challenges to PrEP uptake.…”