Determinants of HIV Pre-Exposure Prophylaxis (PrEP) Retention among Transgender Women: A Sequential, Explanatory Mixed Methods Study

Jack Andrzejewski (), Heather A. Pines, Sheldon Morris, Leah Burke, Robert Bolan, Jae Sevelius, David J. Moore and Jill Blumenthal
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Jack Andrzejewski: San Diego Joint Doctoral Program in Public Health, San Diego State University—University of California San Diego, San Diego, CA 92093, USA
Heather A. Pines: School of Public Health, San Diego State University, San Diego, CA 92182, USA
Sheldon Morris: Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA
Leah Burke: Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA
Robert Bolan: LA LGBT Center, Los Angeles, CA 90038, USA
Jae Sevelius: Department of Psychiatry, Columbia University, New York, NY 10032, USA
David J. Moore: Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
Jill Blumenthal: Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA

IJERPH, 2024, vol. 21, issue 2, 1-13

Abstract: Transgender women (TW) face inequities in HIV and unique barriers to PrEP, an effective biomedical intervention to prevent HIV acquisition. To improve PrEP retention among TW, we examined factors related to retention using a two-phase, sequential explanatory mixed methods approach. In Phase I, we used data from a trial of 170 TW who were provided oral PrEP to examine predictors of 24-week retention. In Phase II, we conducted 15 in-depth interviews with PrEP-experienced TW and used thematic analysis to explain Phase I findings. In Phase I, more participants who were not retained at 24 weeks reported sex work engagement (18% versus 7%) and substantial/severe drug use (18% versus 8%). In Phase II, participants reported drug use as a barrier to PrEP, often in the context of sex work, and we identified two subcategories of sex work. TW engaged in “non-survival sex work” had little difficulty staying on PrEP, while those engaged in “survival sex work” struggled to stay on PrEP. In Phase I, fewer participants not retained at 24 weeks reported gender-affirming hormone therapy (GAHT) use (56% versus 71%). In Phase II, participants prioritized medical gender affirmation services over PrEP but also described the bidirectional benefits of accessing GAHT and PrEP. TW who engaged in “survival sex work” experience barriers to PrEP retention (e.g., unstable housing, drug use) and may require additional support to stay in PrEP care.

Keywords: PrEP; transgender women; HIV; sex work; substance use; gender affirmation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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