Barriers to Accessing and Engaging in HIV Preventive Care and Pre-Exposure Prophylaxis Experienced by Transgender Women in Florida

Allysha C. Maragh-Bass (), Sandra Kiplagat, Sarah Lavari, Francisco Sastre, Jessy G. Devieux, Daniel Jimenez, Rachel D. Clarke, Ines Noel, Eric W. Schrimshaw, Jae Sevelius and Elena Cyrus
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Allysha C. Maragh-Bass: Global Health and Population Division, FHI 360, Durham, NC 27701, USA
Sandra Kiplagat: Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
Sarah Lavari: Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
Francisco Sastre: Department of Psychology, Carlos Albizu University, Miami, FL 33172, USA
Jessy G. Devieux: Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
Daniel Jimenez: Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
Rachel D. Clarke: Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
Ines Noel: Department of Psychology, College of Arts and Science, New York University, New York City, NY 10003, USA
Eric W. Schrimshaw: Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
Jae Sevelius: Department of Prevention Science, University of California, San Francisco, CA 94158, USA
Elena Cyrus: Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL 32827, USA

IJERPH, 2024, vol. 21, issue 3, 1-18

Abstract: Background: PrEP, a biomedical HIV prevention option, continues to be underutilized among transgender women who could benefit from sustained use, especially women of color and those who identify as Latina and/or reside in the southeastern US. Objective: We explored the barriers and facilitators experienced by transgender women who live in Florida regarding accessing, using, and/or staying on PrEP. Methods: In-depth interviews and focus groups were conducted in either Spanish or English with adult transgender women living in Florida (N = 22). The interviews were audio-recorded, transcribed, and coded in ATLAS.ti using thematic analyses. Results: The mean age of the participants was 42.2 years. Among the participants, 73% were Hispanic/Latina, 59% were foreign-born, and approximately one-third were living with HIV (but had past experience with PrEP). Transgender women cited the following barriers to accessing or considering PrEP: (1) costs and benefits of PrEP use; (2) under-representation in clinical trials resulting in unknown or misinformation regarding PrEP side effects; (3) chronic poverty; and (4) trauma and discrimination. Other stressors, such as behavioral healthcare needs, were identified. Conclusions: Our analysis revealed interlocking systems of oppression like transphobia, discrimination, and misgendering, which were common barriers experienced by our participants. These synergistically epidemic (i.e., syndemic) barriers contributed to their feelings of being systematically excluded in social spaces, research, public health planning and policies, laws, and social programs related to PrEP. These structural barriers are impediments to HIV preventive care but also act as a source of stress that contributes to mental health problems, financial vulnerability, substance abuse, and other deleterious health outcomes.

Keywords: transgender women; Florida; HIV; PrEP; barriers to care (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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