The systemic and interpersonal barriers to HIV PrEP access among Black and Latinx transgender men and women: a qualitative study
MetadataShow full item record
There is limited data regarding human immunodeficiency virus (HIV) prevalence among transgender individuals. Further complicating the absence of knowledge, transgender women are often conflated with men who have sex with men (MSM). Approximately half of transgender men and women who live with HIV are from the Southern region of the United States (US). While transgender women are more likely to contract HIV compared to transgender men, approximately two-thirds of transgender individuals have not tested for HIV, likely leading to underreporting. Among the 14% of transgender women diagnosed with HIV/AIDS in the US, 44% are Black, (despite representing only 25% of the population in the US), and 26% are Latinx, which is four times the prevalence rate of White transgender women (7%). Pre-exposure prophylaxis (PrEP) is an HIV prevention method in which individuals at risk for HIV can take a daily pill to reduce the risk of contracting HIV. Previous PrEP research has been conducted among transgender women and men, Black and Latinx MSM, and cisgender women. However, there is limited research on barriers to PrEP adoption among Black or Latinx transgender women and men. This study aims to evaluate barriers to PrEP interest and adoption to better address issues faced by Black and Latinx transgender men and women. A meta-analysis of HIV prevalence among transgender women identified a need for HIV prevention as transgender women are at high risk for HIV. In a study with a sample of 233 transgender women in the US, only 13.7% were aware of PrEP (Wilson et al., 2016). Among studies including Black and Latinx transgender women, barriers to PrEP adoption included: medical mistrust, lack of knowledge (e.g., side effects), PrEP stigma among community members and doctors, perceived/actual discrimination regarding having sex with men by providers and advertisements, concerns regarding interactions with hormone therapy, and objections by romantic partners. Social support following PrEP use disclosure is associated with greater self-esteem for one’s transgender identity and greater likelihood of PrEP use. Among black and Latinx trans men, barriers to PrEP included lack of support from family and discrimination. Other barriers that Black and Latinx cisgender women face, which may be applicable to Black or Latinx transgender women and men, are lower educational attainment, income, decreased access to healthcare services, medical mistrust, language barriers, racial bias from medical providers, and lack of social support. Awareness of PrEP has been lower among those who are less educated and whose primary care providers are unaware that they have sex with men. One study showed that those with lower income and less than a high school education were associated with poorer medication adherence and greater risk of death even when controlling for HIV treatment. In another study examining potential barriers to PrEP acceptability and adherence, efficacy and side effects were notable barriers to PrEP initiation among 78% of MSM and transgender women participants, which were more commonly reported among Black compared to White participants. Given the dearth of research among Black and Latinx trans men and women regarding barriers to PrEP adoption, it is essential to evaluate systemic and interpersonal barriers to PrEP access that are unique to Black and Latinx transgender communities.