Transgender Women's Attitudes Towards HIV PrEP

A recent study published in the Journal of Adolescent Health has shown that many young transgender women (YTW) are aware of HIV pre-exposure prophylaxis (PrEP) and have positive attitudes toward it.

“A key challenge in PrEP implementation involves increasing knowledge and uptake in populations at highest risk of HIV acquisition,” write Sarah M. Wood, MD, from the University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues.

According to the authors, transgender women experience stigma, employment discrimination, and violence, which often lead to participation in sex work, economic marginalization, homelessness, and poor access to gender-affirming healthcare. Indeed, two-thirds of YTW have exchanged sex for housing, food, drugs, or money, they add.

As a result, Dr. Wood and colleagues say that YTW are disproportionately affected by HIV. The estimated HIV prevalence in this population ranges from 5% to 22%, and they are 49 times more likely than other adults of reproductive age to acquire HIV.

Most health insurance companies cover PrEP as a way to prevent people from getting HIV infection, and patient assistance programs also help with drug or copayment costs. However, for people who do not qualify for this assistance, out-of-pocket costs may be as high as $17,000 each year for PrEP. This high cost inevitably limits access to the drug in this economically marginalized population.

Previous studies have also demonstrated rates of PrEP awareness as low as 31% among YTW. Due to this discordance between the high need for PrEP and its low rate of awareness in this unique population, the researchers conducted their study to investigate factors that affect PrEP uptake among YTW.

They performed in-depth interviews with 25 YTW between 17- and 24-years-old, who were of either HIV-negative or unknown HIV status. “In our study, 64% of participants had prior awareness of PrEP, a higher estimate than cited previously,” the authors write. Although this may suggest increased release of information about PrEP in recent years, the authors say it may also reflect the importance of social media as a source of information sharing among young individuals. Indeed, study participants cited several social media platforms as a source of PrEP information.

According to the authors, 28% of participants also reported current use or intent to use PrEP.

When individuals without previous knowledge of PrEP received information about it, they developed overwhelmingly positive attitudes about PrEP, and also stressed the need to improve PrEP awareness among YTW.

Nevertheless, even among those with previous awareness of PrEP, participants showed variability in their PrEP awareness, barriers and facilitators to their PrEP uptake, and in perceived emotional benefits of PrEP.

Although this study shares a view into attitudes toward PrEP in a hard-to-reach population, Dr. Wood and colleagues acknowledge that participants received only limited information about PrEP during interviews. “[F]uture studies should explore perspectives on PrEP in a context where participants are informed of many of the nuances of PrEP utilization including cost, coverage, toxicities, and adherence,” the authors conclude.

Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals, and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.