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Exploring barriers and facilitators to PrEP use among transgender women in two urban areas: implications for messaging and communication
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BMC Public Health (2022)
Understanding how PrEP is conceived, and how best to communicate the benefits of PrEP to trans women is critical to ensure they receive culturally appropriate messages that resonate with and address their needs.
"Results of this study indicate that important areas for future research include how to best provide trans-specific education and messaging about PrEP that ensures that trans women know about recent evidence of the safety of using PrEP and hormones [44] and addressing misinformation about PrEP use contributing to drug resistance."
"communication is the proverbial "two-way street" and both providers and public health practitioners working with trans women need to ensure they are communicating not only the right messages but in the right context. Providers will need to better discuss the benefits of PrEP by addressing the concerns trans women may have in how it could potentially affect their transition. Additionally, providers may need to bring up PrEP in more than one session to help patients build comfort with addressing sexuality and gender, and to lessen feelings of mistrust. It is also important for them to stress the importance of daily adherence with their patients to optimize PrEP effectiveness and its minimal impact on hormone use."
"Above all, it is important that educational messages and materials about PrEP are specifically geared to address trans women's concerns, crafted in language that is widely accessible and used in interventions. Our participants emphasized how important it is to be provided PrEP information from respected community members and that a "one size fits all" approach will not work – this is especially pertinent for trans women of color who expressed the importance of racial representation in PrEP messaging. Recruiting trans women from a variety of identities who can speak from experience about PrEP will be essential in future communication interventions aimed at increasing knowledge and eventual uptake of PrEP. These community advocates can be an important bridge to healthcare, boosting confidence in asking for and discussing PrEP use with healthcare providers.
Abstract
Background
Trans women are at increased risk for HIV infection yet are less likely to use pre-exposure prophylaxis (PrEP) medication as a preventive measure. PrEP messaging and marketing has focused on men who have sex with men (MSM) or included trans women as a subset of MSM, ignoring the potential barriers to PrEP use unique to trans women. Little is known about how this group conceptualizes PrEP, what knowledge gaps still exist, and how trans women believe PrEP should be communicated to increase use.
Methods
This qualitative study conducted focus groups (n = 5) in Philadelphia and Sacramento with trans women to assess these issues.
Results
Twelve sub-themes were found related to five main domains, including PrEP knowledge, benefits, barriers, community-related considerations, and messaging/marketing. Findings indicate that knowledge of PrEP is still low and beliefs about PrEP's effects on hormone use persist. Most importantly, participants voiced a demand for culturally appropriate trans-specific messages in HIV prevention interventions and communication.
Conclusions
Without acknowledging specific barriers to PrEP uptake among transgender women separate from those of MSM and incorporating gender affirmation into PrEP education, simply knowing PrEP is available may not motivate trans women to use PrEP. This has important implications for future efforts to communicate about PrEP with trans women.
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