- Sexual violence and stigmatization drive low uptake of pre-exposure prophylaxis (PrEP) among HIV-negative transgender women in South Africa.
Why this matters
- Address structural barriers to PrEP access, including stigmatization, health care access, price.
- Develop transgender woman-specific education that leverages network support for, engagement with, and adherence to PrEP.
- Consider adverse effects related to concomitant hormones and PrEP.
- 213 participants; median age, 26 (range, 18-59) years.
- 36 also participated in in-depth qualitative interviews.
- 45% (57) of HIV-negative participants had heard of PrEP, 36% of whom knew where to get it.
- 11% were currently taking PrEP.
- 41% (44/108) of PrEP-aware transgender women knew others taking PrEP.
- Factors driving PrEP knowledge:
- Lifetime history of sexual (61%) or physical (48%) violence,
- Employment (52%) or housing discrimination (50%),
- Incarceration (60%), and
- Homelessness (83%).
- 59% had medical mistrust.
- Multivariate factors linked to barriers to PrEP uptake (prevalence ratios):
- Lifetime sexual violence: 1.48 (P=.20).
- Community connectedness score per 1 point increase: 0.87 (P=.029).
- Current employment: 0.59 (P=.011).
- Cross-sectional, convergent, parallel analysis of PrEP awareness, uptake, desire, associated barriers/facilitators in South African transgender women.
- Funding: Gilead Sciences.
- Nongeneralizable (convenience sample).
- Social desirability bias.