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Barriers and Facilitators to PrEP Initiation and Adherence Among Transgender and Gender Non-Binary Individuals in Southern California
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Dec 2020
Abstract
While transgender and gender non-binary (trans/nb) individuals are disproportionately affected by HIV, pre-exposure prophylaxis (PrEP) uptake remains low in this underserved population. We conducted four focus groups with 37 trans/nb individuals in San Diego and Los Angeles to assess barriers and facilitators of PrEP usage. Transcripts were coded for qualitative themes. Although overall PrEP awareness was high, participants reported limited knowledge and misinformation about PrEP. Barriers to PrEP use included: structural access (e.g., discrimination from health care providers, lack of trans-inclusive services, financial barriers), mental health struggles limiting ability to access PrEP, and concerns about potential side effects, drug-drug interactions with hormone therapy, and lack of other STI protection. Facilitators of PrEP usage included: increased PrEP availability, prior experience taking daily medications, and motivation to have active and healthy lives without fear of contracting HIV. Addressing both structural and psychosocial/behavioral factors in trans-affirming health care environments is crucial to designing inclusive, effective PrEP interventions.
In preparation for an open-label PrEP demonstration project designed for trans/nb individuals in Southern California, the present study was designed to explore PrEP awareness and identify trans-specific perceived barriers and facilitators of PrEP uptake. Focus groups with trans women, trans men, and non-binary individuals were conducted in Los Angeles and San Diego to inform how to best support PrEP initiation and adherence in this community. The goal of this article is to identify the broad PrEP-related themes raised by focus groups, and to provide an in-depth explo-ration of the multiple, intersecting factors identified by trans/nb individuals pertinent to increasing PrEP awareness and access.
Four focus groups in San Diego (n = 9; n = 9) and Los Angeles (n = 9, n = 10) were conducted with 37 trans/nb individuals 18 years or older between December 2016 and January 2017, as a part of the California HIV/AIDS Research Program-funded (CHRP) PrEP for Transgender People. Focus groups took place at the University of California, San Diego (UC San Diego) Antiviral Research Center (AVRC) in San Diego and the Los Angeles LGBT Center (the Center) in Los Angeles, and were conducted primarily in English. Participants who identified as transgender, gender non-binary, or gender non-conforming were recruited through local clinics, community-based orga-nizations and advisory boards, HIV/STI testing sites, and local participant referral of trans/nb social network members.
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