Violence, stigma drive low PrEP engagement among transgender women in S Africa

  • Poteat T & al.
  • Lancet HIV
  • 02.07.2020

  • von Liz Scherer
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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).

Study design

  • Cross-sectional, convergent, parallel analysis of PrEP awareness, uptake, desire, associated barriers/facilitators in South African transgender women. 
  • Funding: Gilead Sciences.

Limitations

  • Nongeneralizable (convenience sample).
  • Cross-sectional.
  • Social desirability bias.