title: 'I am not a man': Trans-specific barriers and facilitators to PrEP acceptability among transgender women.
abstract: The frequent conflation of transgender ('trans') women with 'men who have sex with men (MSM)' in HIV prevention obscures trans women's unique gender identities, social and behavioural vulnerabilities, and their disproportionately high rates of HIV infection. Pre-exposure prophylaxis (PrEP) is an efficacious biomedical HIV prevention approach. However, trans women are underrepresented in PrEP research, and are often aggregated with MSM without consideration for their unique positions within sociocultural contexts. This study examined PrEP acceptability among trans women via three focus groups and nine individual interviews (total N = 30) in San Francisco. While knowledge of PrEP was low, interest was relatively high once participants were informed. Due to past negative healthcare experiences, ability to obtain PrEP from a trans-competent provider was cited as essential to PrEP uptake and adherence. Participants noted that PrEP could address situations in which trans women experience reduced power to negotiate safer sex, including sex work. Trans-specific barriers included lack of trans-inclusive marketing of PrEP, prioritisation of hormone use, and medical mistrust due to transphobia. Findings underscore the importance of disaggregating trans women from MSM in HIV prevention strategies to mitigate disparate risk among this highly vulnerable population.
authors.affiliation: a Department of Family & Community Medicine , Center of Excellence for Transgender Health, University of California , San Francisco , CA , USA.|b Department of Medicine , Center for AIDS Prevention Studies, University of California , San Francisco , CA , USA.
authors.forename: Jae M
authors.initials: JM
authors.lastname: Sevelius
authors.affiliation: a Department of Family & Community Medicine , Center of Excellence for Transgender Health, University of California , San Francisco , CA , USA.
authors.forename: JoAnne
authors.initials: J
authors.lastname: Keatley
authors.affiliation: c Trans Thrive Program, Asian & Pacific Islander Wellness Center , San Francisco , CA , USA.
authors.forename: Nikki
authors.initials: N
authors.lastname: Calma
authors.affiliation: b Department of Medicine , Center for AIDS Prevention Studies, University of California , San Francisco , CA , USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Arnold
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D017144:Focus Groups; D005783:Gender Identity; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006293:Health Promotion / Q000379:methods* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008389:Marketing of Health Services / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D065129:Pre-Exposure Prophylaxis / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D063106:Transgender Persons / Q000523:psychology* / Q000706:statistics & numerical data; D035862:Vulnerable Populations; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV prevention; Transgender; pre-exposure prophylaxis; women