Truvada as Pre-exposure prophylaxis (PrEP) is an efficacious biomedical prevention modality for individuals at increased risk of becoming infected with HIV, including young transgender women (YTW). However, no published studies to our knowledge have examined PrEP acceptability and its associated factors among this group. The current study examined the prevalence of PrEP acceptability and related factors among HIV uninfected, YTW in two major urban cities in the US.
Between 2012 to 2015, 300 sexually active YTW (aged 16-29) from Boston and Chicago enrolled in Project LifeSkills, the first behavioral HIV prevention efficacy trial for transgender women in the US. YTW were asked to complete a baseline assessment of socio- demographics and healthcare utilization characteristics, as well as PrEP acceptability, interest, and awareness. The present analysis was restricted to HIV uninfected YTW (n = 230), who maybe likely candidates for PrEP. Factors associated with PrEP acceptability (continuous scores, sample mean=23.4, range=10.0-30.0) were examined using multiple linear regression procedures.
Participants’ mean age was 23 years; the sample was 42% black, 13% Latina, 33% white, and 12% other minority race/ethnicity. In a final model, PrEP interest (β = 3.7, 95% Confidence Interval [95%CI] = 2.2 – 5.2) and having providers who meet YTW’s health needs (β = 2.9, 95%CI = 1.3 – 4.4) were associated with an increase in PrEP acceptability scores, whereas younger age (aged 21-25 vs 26-29 years) (β = –2.0, 95%CI = -3.6 – -0.4) and reporting transactional sex in the last 4 months (β = –1.5, 95% CI = -3.0 – -0.1) were associated with lower PrEP acceptability scores (all p’s<0.05). The majority (66.1%) of YTW in this sample were interested in PrEP use. The most commonly reported reasons for being uninterested in PrEP included 1) concerns related to medication side effects (20.5%) and 2) mistrust with medical providers (16.7%).
Overall, PrEP acceptability was high among this community-recruited sample of sexually active YTW. Interventions that seek to build trust between providers and YTW, as well as provide culturally responsive sources of educational materials on PrEP related side effects may bolster PrEP acceptability, particularly among youth or those with recent sex work. PrEP programs that seek to meet YTW’s other health needs (e.g., hormone therapy) in addition to PrEP services may also increase PrEP acceptability.