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Awareness, Willingness, and PrEP Eligibility Among Transgender Women in Rio de Janeiro, Brazil

Jalil, Emilia M., PhD*; Grinsztejn, Beatriz, MD*; Velasque, Luciane, PhD; Ramos Makkeda, Alessandra, BSocSc; Luz, Paula M., PhD*; Moreira, Ronaldo I., BSc*; Kamel, Luciana, MSc*; Fernandes, Nilo M., PhD*; Ferreira, Ana Cristina G., MD*; Hoagland, Brenda, PhD*; Wagner, Sandra, PhD*; Liu, Albert, MD§; McFarland, Willi, PhD‖,¶; Buchbinder, Susan, MD§,‖,¶; Veloso, Valdilea G., MD*; Wilson, Erin, DrPH§ for Transcender Study Team

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1, 2018 - Volume 79 - Issue 4 - p 445–452
doi: 10.1097/QAI.0000000000001839
Prevention Research

Background: HIV epidemics disproportionately affect transwomen worldwide. Trans-specific guidance, outreach, and interventions to increase pre-exposure prophylaxis (PrEP) use among transwomen are scarce.

Setting: Rio de Janeiro, Brazil.

Methods: We measured awareness and willingness to use PrEP and examined factors associated with those outcomes among transwomen in Rio de Janeiro and estimated how many transwomen would be eligible for PrEP. Data originate from Transcender study, a respondent-driven sampling survey conducted from August 2015 to January 2016. We performed regression models for PrEP awareness and willingness.

Results: One hundred thirty-one (38.0%) of 345 participants had heard of PrEP. Among transwomen who self-reported as HIV-negative, 162 (76.4%, N = 212 with available data) reported willingness to use it and 163 (66.8%, N = 244) met PrEP behavioral eligibility criteria. Transwomen with health access in the previous 6 months who reported HIV-infected sexual partner and with 8+ years of schooling had increased odds of PrEP awareness. Lower PrEP awareness was associated with condomless anal intercourse and newly diagnosed HIV infection. Younger age and perceiving themselves at risk of HIV infection increased the odds of PrEP willingness. Lower odds of PrEP willingness were associated with concerns about long-term effects of PrEP and with difficulties in getting access to health care due to transphobia.

Conclusion: Combination of low awareness, high willingness, and substantial PrEP eligibility corroborates transwomen as a key population for HIV prevention. PrEP is a promising and empowering strategy for HIV prevention among transwomen, but trans-specific recommendations are needed to effectively implement PrEP in this population.

*STD and AIDS Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil;

Departamento de Matemática e Estatística, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil;

Rio de Janeiro Federal Institute of Education, Science and Technology, Niterói, RJ, Brazil;

§Bridge HIV, San Francisco Department of Public Health, San Francisco, CA; and

Departments of Medicine; and

Epidemiology and Biostatistics, UCSF, San Francisco, CA.

Correspondence to: Emilia M. Jalil, MD, PhD, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil, 4365 Manguinhos, Rio de Janeiro, RJ 21040-360, Brazil (e-mail:

Supported in part by Brazilian Research Council (470056/2014-2) and NIAID-NIH (UM1AI069496). B.G. and P.M.L. acknowledge funding from Brazilian Research Council (CNPq) and Scientific Development and Research Funding Agency of the State of Rio de Janeiro. The authors acknowledge the CNPq and the National Institute of Allergy and Infectious Diseases (NIAID-NIH) for funding this study.

Presented in part at the HIV Research for Prevention 2016; October 17, 2016; Chicago, IL.

The authors have no funding or conflicts of interest to disclose.

Authors' contributions: B.G., E.M.J., W.F., E.W., S.B., and V.G.V. conceived the study and interpreted the findings. B.G., E.M.J., E.W., and V.G.V. drafted the manuscript. L.V. performed the statistical analyses with aid from R.I.M., E.M.J., E.W., and P.M.L. L.V., R.I.M., A.C.G.F., and P.M.L. helped with data acquisition, interpretation of the results, and drafting the manuscript. A.R.M., S.W., and B.H. helped with interpretation of the results and drafting the manuscript. W.F., A.L., and S.B. were involved in revising the manuscript for important intellectual content. All authors read and approved the final manuscript.

Received March 08, 2018

Accepted July 18, 2018

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