*Note* This scheduling program was not designed by folks who do a lot with APA Style and unfortunately it defaults to listing authors in alphabetical order. We cannot fix this for this online schedule, but the author orders are posted in the order submitted in the printed program available via pdf here.
Transgender women (‘transwomen’) are at disproportionate risk of acquiring HIV. Pre-exposure prophylaxis (PrEP) represents the first efficacious biomedical HIV prevention approach. However, a subanalysis of the iPrEx data revealed zero efficacy among transwomen in the trial. Furthermore, transwomen are excluded or underrepresented in PrEP research, often aggregated with MSM without consideration for their unique positions within sociocultural contexts. This study examined culturally specific facilitators and barriers to PrEP acceptability among urban transwomen at risk for HIV. We conducted 3 focus groups and 9 individual interviews with transwomen (total N=30) in San Francisco focused on their knowledge of, interest in, and concerns about PrEP for HIV prevention. Transcripts were analyzed for common themes; a team of researchers applied analytic codes using Atlas.ti. Due to negative experiences with healthcare providers and healthcare settings, ability to obtain PrEP from a trans-friendly provider (particularly the same trusted provider that prescribes their hormones) was cited as essential to PrEP uptake and adherence. While knowledge of PrEP was low, interest was relatively high. Participants noted that use of PrEP could address several aspects of transwomen’s lives that increase their HIV risk, including sex work and low power to negotiate safer sex. Barriers to PrEP use included concerns about interactions with hormones, managing multiple medications, potential side effects, and avoidance of medical settings. Findings underscore an urgent need to disaggregate transwomen from MSM in HIV prevention strategies, emphasizing several trans-specific facilitators and concerns to inform dissemination of PrEP among urban transwomen. Ongoing failure to consider positions of transwomen’s bodies and sexualities within fraught sociocultural contexts, including medical settings, has limited the effectiveness of HIV prevention efforts to mitigate disparate risk among this highly vulnerable and unique group.
