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Factors Associated with PrEP Refusal Among Transgender Women in Northeastern Brazil

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Abstract

Brazil has recently integrated HIV Pre-exposure Prophylaxis (PrEP) into its public health system and offered to key populations such as transgender women (TGW). This study investigates factors associated with PrEP refusal among TGW living in one of the largest and poorest cities of Brazil. We recruited 127 TGW using Respondent Driven Sampling (RDS) in Salvador, Brazil. Latent class analysis (LCA) was used to define acceptability of PrEP. Two latent classes were identified: “high acceptability of PrEP” (91.3%) and “PrEP refusal” (8.7%). PrEP was less acceptable among white TGW and among those age 25 or older, with income above minimum wage (≥ US$252.87), and reporting unprotected receptive anal intercourse with (URAI) causal partners. The findings highlight how nuanced strategies that takes into consideration unique characteristics are needed to effectively address the acceptability of PrEP.

Resumen

Brasil ha integrado recientemente la Profilaxis de Preexposición (PrEP) ao VIH en su sistema de salud pública y se ofrece a las poblaciones claves como las mujeres transgénero (TGW). Este estudio investiga los factores asociados al rechazo de la PrEP entre las TGW que viven en una de las ciudades más grandes y más pobres de Brasil. Reclutamos 127 TGW utilizando Respondent Driven Sampling (RDS) en Salvador, Brasil. El análisis de clase latente (LCA) se usó para definir la aceptabilidad de PrEP. Se identificaron dos clases latentes: “alta aceptabilidad de PrEP” (91.3%) y “recusa da PrEP” (8.7%). La PrEP fue menos aceptable entre las TGW de piel blanca, de 25 años o más, con ingresos de > $ 252.87 dólares y con relaciones anales receptivas no protegidas con parejas casuales (RARNP). La PrEP fue muy aceptable en esta muestra de las TGW en el nordeste de Brasil. Sin embargo, las TGW con mayor riesgo de infección por VIH, que generalmente tienen RARNP, estaban menos dispuestas a usar PrEP.

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Acknowledgements

The authors would like to express their gratitude to the participants of the study, to the local team that carried out the fieldwork in Salvador and all the collaborating NGO: Association of Transvestites in Salvador (Associação de Travestis de Salvador: ATRAS); Conceição Macedo Beneficent Institute (Instituto Beneficente Conceição Macedo: IBCM). Additionally, we appreciate the CAPES support for the Master´s fellowship granted to FS. The funding financial support for this study was provided by Brazilian Ministry of Health, through its Secretariat for Health Surveillance and its Department of Prevention, Surveillance and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis through a grant number: 225,943/2014. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia, CEP: 40.110-040, Brazil

    Fabiane Soares, Laio Magno, Luís Augusto Vasconcelos da Silva, Leila Amorim & Inês Dourado

  2. Rand Corp, Santa Monica, CA, USA

    Sarah MacCarthy

  3. Department of Life Science, State University of Bahia (Universidade do Estado da Bahia/Departamento de Ciências da Vida), Salvador, BA, Brazil

    Laio Magno

  4. Institute of Humanities, Arts and Sciences Professor Milton Santos, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Humanidades, Artes e Ciências Professor Milton Santos), Salvador, BA, Brazil

    Luís Augusto Vasconcelos da Silva

  5. Institute of Mathematics and Statistics, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Matemática e Estatística), Salvador, BA, Brazil

    Leila Amorim

  6. School of Public Health, Brown University, Providence, RI, USA

    Amy Nunn

  7. Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, CA, USA

    Catherine E. Oldenburg

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  1. Fabiane Soares
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Soares, F., MacCarthy, S., Magno, L. et al. Factors Associated with PrEP Refusal Among Transgender Women in Northeastern Brazil. AIDS Behav 23, 2710–2718 (2019). https://doi.org/10.1007/s10461-019-02501-z

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