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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 PhD*,1,a; Wirtz, Andrea PhD1; Malik, Mannat MHS1; Cooney, Erin MSPH1; Cannon, Christopher MPH2; Hardy, W. David MD2,b; Arrington-Sanders, Renata MD, MPH, ScM3; Lujan, Maren MA4; Yamanis, Thespina PhD4

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 28, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002112
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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-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 (i.e., 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.

Conclusion: 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.

1Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology

2Research Department, Whitman-Walker Health, Washington, DC, USA

3Johns Hopkins University School of Medicine, Division of Pediatrics and Adolescent Medicine

4American University, School of International Service

Corresponding Author: Tonia Poteat, Department of Social Medicine, CB #7240, University of North Carolina at Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC 27599-7240 Email: tonia_poteat@med.unc.edu; Phone: 919-445-6364; Fax: 919-966-7499

The authors report no conflicts of interest related to this work.

a University of North Carolina at Chapel Hill, Department of Social Medicine,

b Johns Hopkins University School of Medicine, Division of Infectious Disease

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