“When Somebody Comes into This Country and You Are Trans on Top of That Is Like You Got… Two Strikes on You”: Intersectional Barriers to PrEP Use Among Latina Transgender Women in the Eastern and Southern United States

Rodrigo A. Aguayo-Romero (), Genesis Valera, Erin E. Cooney, Andrea L. Wirtz and Sari L. Reisner
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Rodrigo A. Aguayo-Romero: The Institute for Health Research & Policy at Whitman Walker, Washington, DC 20009, USA
Genesis Valera: The Fenway Institute, Fenway Health, Boston, MA 02215, USA
Erin E. Cooney: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Andrea L. Wirtz: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Sari L. Reisner: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA

IJERPH, 2025, vol. 22, issue 5, 1-20

Abstract: In the United States (U.S.), Latina transgender women (LTW) are highly burdened by HIV and are prioritized for pre-exposure prophylaxis (PrEP). This study explored intersectional barriers and facilitators to PrEP uptake among LTW. Between February–November 2022, in-depth interviews were conducted with 27 LTW in the LITE Study. Participants were purposively sampled from 196 LTW in the cohort based on PrEP uptake (PrEP-naïve n = 8, PrEP-eligible and not user n = 5, current PrEP user n = 6, previous PrEP user n = 8). We conducted content analysis guided by a Modified Social Ecological Model and Intersectionality Framework. The mean age of participants was 32.3 (SD = 12.9). Themes were: (1) Intrapersonal: Medical distrust, acceptability of PrEP modalities, and concerns about long-term health; (2) Interpersonal: Mistreatment in healthcare, discrimination-related healthcare avoidance, difficulty finding trans-competent providers, language barriers, and shame and stigma; and (3) Structural: PrEP in the context of limited access to gender-affirming care and widespread silicone use, immigration status, economic marginalization, lack of community outreach, transphobia and anti-transgender legislative contexts, and xenophobia. This study found multilevel intersectional barriers influence PrEP uptake and persistence. Culturally tailored HIV prevention efforts are needed to address LTW-specific barriers, provide information on programs subsidizing PrEP, and implement policy change to ensure equitable PrEP access.

Keywords: HIV; HIV prevention; transgender; pre-exposure prophylaxis; intersectionality; stigma; discrimination (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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