Background
Latinx and Black transgender women (TGW) often face unique social, economic, and healthcare barriers that may limit their access to HIV prevention tools like PrEP. Research on racial disparities in PrEP use in these groups is limited. This study examined trends in PrEP uptake among Latinx and Black TGW in Los Angeles County (LAC) from 2019 to 2023 and investigated correlates of PrEP use.
Methods
We analyzed data from the National HIV Behavioral Surveillance system. The analysis was limited to HIV-negative Latinx and Black TGW residing in LAC who participated in surveys conducted in 2019 (n=295) and 2023 (n=351). To assess the changes in past-year PrEP use between 2019 and 2023, a log-linked Poisson regression model was applied, adjusting for demographic and healthcare-related covariates including age, insurance, recent medical visits, hormone therapy use, and substance use history.
Results
Between 2019 and 2023, significant differences in PrEP use were observed in Latinx compared with Black TGW. In 2019, PrEP use was similar (28% for Latinx TGW, n=231, and 27% for Black TGW, n=64), but by 2023, PrEP use had increased by 61% to 45% among Latinx TGW(n=240) and decreased by 11% to 24% among Black TGW (n=111). After accounting for influential covariates, Latinx TGW remained significantly more likely to show a greater increase in PrEP use from 2019 to 2023 compared with Black TGW (adjusted Prevalence Ratio[aPR]= 1.9, 95% CI [1.1, 3.4]. Hormone therapy use within the past 12 months was positively correlated with PrEP use in both Black and Latinx TGW (aPR=1.6, 95% CI [1.2-2.0]). Further analysis showed having insurance was positively correlated with hormone therapy use for both Black and Latinx TGW (p <0.01).
Conclusions
This study revealed disparity in changes in PrEP use from 2019 to 2023 between Latinx and Black TGW. The significant increase in PrEP uptake among Latinx TGW suggested that HIV prevention campaigns targeting Latinx communities had been effective. However, the lack of progress among Black TGW pointed to the urgent need for more racially and culturally tailored interventions addressing the unique social determinants of health within the Black TGW community. The positive correlation between use of hormone therapy and PrEP suggested that integrating gender-affirming care into HIV prevention strategies would be beneficial. Mobilizing the Black TGW community to increase access to PrEP should be a priority to achieve the goals of the Ending the HIV Epidemic initiative.