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A Gap Between Willingness and Uptake

Findings From Mixed Methods Research on HIV Prevention Among Black and Latina Transgender Women

Poteat, Tonia PhDa,b; Wirtz, Andrea PhDa; Malik, Mannat MHSa; Cooney, Erin MSPHa; Cannon, Christopher MPHc; Hardy, W. David MDc,d; Arrington-Sanders, Renata MD, MPH, ScMe; Lujan, Maren MAf; Yamanis, Thespina PhDf

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1, 2019 - Volume 82 - Issue 2 - p 131–140
doi: 10.1097/QAI.0000000000002112
Prevention Research

Background: Black and Latina transgender women (BLTW) face significant HIV disparities with estimated HIV prevalence up to 50% and annual incidence rates as high as 2.8 per 100 person-years. However, few studies have evaluated the acceptability and uptake of high-impact HIV prevention interventions among BLTW.

Setting: Data collection took place in Baltimore, MD and Washington, DC from May 2015 to May 2017.

Methods: This mixed methods study included quantitative interviewer-administered surveys, key informant interviews, and focus group discussions. Rapid HIV testing followed each survey. Logistic regression models tested associations between legal gender affirmation (ie, desired name and gender marker on identity documents), transgender pride, history of exchange sex, HIV risk perception, and willingness to take pre-exposure prophylaxis (PrEP). Transcripts of qualitative data were coded to identify common themes related to engagement in HIV prevention.

Results: Among 201 BLTW, 56% tested HIV-positive and 87% had heard of PrEP. Only 18% who had heard of PrEP had ever taken it. Of the 72 self-reported HIV-negative or status-unknown BLTW who had never taken PrEP, 75% were willing to take it. In multivariable analyses, history of exchange sex was associated with willingness to take PrEP, whereas greater HIV knowledge and transgender pride were associated with lower likelihood of willingness to take PrEP. Concern about drug interactions with hormone therapy was the most frequently reported barrier to PrEP uptake.

Conclusions: Noting the disconnect between PrEP willingness and uptake among BLTW, HIV prevention programs could bridge this gap by responding to identified access barriers and incorporating community-derived strategies.

aDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;

bDepartment of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC;

cResearch Department, Whitman-Walker Health, Washington, DC;

dDivision of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD;

eDivision of Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; and

fAmerican University, School of International Service, Washington, DC.

Correspondence to: Tonia Poteat, PhD, Department of Social Medicine, University of North Carolina at Chapel Hill, CB #7240, 333 S. Columbia Street, Chapel Hill, NC 27599-7240 (e-mail:

Supported by the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), and by services from the District of Columbia Center for AIDS Research, an NIH-funded program (AI117970), which are both supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Presented in part at the International AIDS Society Conference; July 25, 2017; Paris, France, American Public Health Association; November 6, 2017; Atlanta, GA, and the Conference on Retroviruses and Opportunistic Infections; March 6, 2018; Boston, MA.

The authors have no conflicts of interest to disclose.

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Received January 19, 2019

Accepted May 22, 2019

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