Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City

  • Christine Tagliaferri Rael
  • Michelle Martinez
  • Rebecca Giguere
  • Walter Bockting
  • Caitlin MacCrate
  • Will Mellman
  • Pablo Valente
  • George J. Greene
  • Susan Sherman
  • Katherine H. A. Footer
  • Richard T. D’Aquila
  • Alex Carballo-Diéguez
Original Paper


Transgender women may face a disparate risk for HIV/AIDS compared to other groups. In 2012, Truvada was approved for daily use as HIV pre-exposure prophylaxis (PrEP). However, there is a dearth of research about barriers and facilitators to PrEP in transgender women. This paper will shed light on transgender women living in New York City’s perceived and actual challenges to using PrEP and potential strategies to overcome them. After completing an initial screening process, four 90-min focus groups were completed with n = 18 transgender women. Participants were asked what they like and dislike about PrEP. Participants identified the following barriers: uncomfortable side effects, difficulty taking pills, stigma, exclusion of transgender women in advertising, and lack of research on transgender women and PrEP. Facilitators included: reducing pill size, increasing the types of available HIV prevention products, and conducting scientific studies to evaluate PrEP in transgender women.


Transgender women Transwomen PrEP HIV prevention Barriers Facilitators 



The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. The research team would like to thank all participants for their time, hard work, and critical insight.


Data collection support was provided by Project AFFIRM (R01 HD079603; Principle Investigator, Walter Bockting, Ph.D.) and a generous grant from the Mac AIDS Fund (MAF CU13-3233). The first author is supported by a training grant (T32 MH019139; Principle Investigator, Theodorus Sandfort, Ph.D.) from the National Institute of Mental Health at the HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute and Columbia University (P30 MH43520; Center Principle Investigator: Robert Remien, Ph.D.). Additionally, research was supported by SLAP-HIV (UM1 AI120184; Principle Investigator, Tomas Hope, Ph.D.) and the Third Coast Center for AIDS Research (P30 AI117943; Principle Investigator, Richard D’Aquila, M.D.).

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Review Board, Human Subjects Committee of the New York State Psychiatric Institute and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Christine Tagliaferri Rael
    • 1
  • Michelle Martinez
    • 2
    • 4
  • Rebecca Giguere
    • 1
  • Walter Bockting
    • 2
  • Caitlin MacCrate
    • 2
    • 3
  • Will Mellman
    • 2
  • Pablo Valente
    • 2
    • 4
  • George J. Greene
    • 5
  • Susan Sherman
    • 6
  • Katherine H. A. Footer
    • 6
  • Richard T. D’Aquila
    • 7
  • Alex Carballo-Diéguez
    • 1
  1. 1.HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia UniversityNew YorkUSA
  2. 2.Program for the Study of LGBT Health at the New York State Psychiatric Institute/Columbia Psychiatry and the Columbia University School of NursingNew YorkUSA
  3. 3.CUNY School of Public HealthNew YorkUSA
  4. 4.Columbia University Mailman School of Public HealthNew YorkUSA
  5. 5.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA
  6. 6.Department of Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  7. 7.Division of Infectious Diseases, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoUSA

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