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      "Some of us, we don't know where we're going to be tomorrow." Contextual factors affecting PrEP use and adherence among a diverse sample of transgender women in San Francisco.

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          Abstract

          Transgender women (TW) are disproportionately affected by HIV. Antiretroviral pre-exposure prophylaxis (PrEP) can reduce TW's vulnerability to HIV, but PrEP uptake has been limited among TW. To explore barriers to PrEP uptake, the study team conducted two semi-structured focus groups with TW in San Francisco at risk for HIV acquisition. A within-case, across-case approach was used to code and analyze emerging themes. Focus group participants were racially and ethnically diverse. A few participants in both groups had heard of PrEP, but some had not. Several said that their health care providers had not told them about PrEP. Participants in both groups had questions about side effects. They expressed medical mistrust and said poverty is an important context for their lives. They described a need for gender affirming health care services and raised concerns about interactions of PrEP with feminizing hormones. Information about side effects and interactions between gender affirming hormones and PrEP need to be explicitly addressed in PrEP education campaigns focusing on TW. Health care institutions and health departments should train clinical staff how to provide affirming care. Gender identity nondiscrimination laws and policies could improve transgender people's ability to earn a living and access health care.

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          Author and article information

          Journal
          AIDS Care
          AIDS care
          Informa UK Limited
          1360-0451
          0954-0121
          May 2020
          : 32
          : 5
          Affiliations
          [1 ] The Fenway Institute, Fenway Health, Boston, MA, USA.
          [2 ] Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA.
          [3 ] Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.
          [4 ] Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, CA, USA.
          [5 ] School of Social Work, Boston University, Boston, MA, USA.
          [6 ] Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
          [7 ] Harvard Medical School, Boston, MA, USA.
          [8 ] Beth Israel Deaconess Medical Center, Boston, MA, USA.
          Article
          10.1080/09540121.2019.1659912
          31482726
          ef6b55c3-1f20-4876-af2b-df450742b204
          History

          PrEP (or prophylaxis),mistrust,hormones,prevention,Transgender,HIV

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