Advertisement

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

Abstract

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.

Keywords

Transgender women Transwomen PrEP HIV prevention Barriers Facilitators 

Notes

Acknowledgements

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.

Funding

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.

References

  1. 1.
    US Food and Drug Administration. FDA approves first drug for reducing the risk of sexually acquired HIV infection. 2012.Google Scholar
  2. 2.
    Kuhns LM, Reisner SL, Mimiaga MJ, Gayles T, Shelendich M, Garofalo R. Correlates of PrEP indication in a multi-site cohort of young HIV-uninfected transgender women. AIDS Behav. 2016;20(7):1470–7.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Escudero DJ, Kerr T, Operario D, Socias ME, Sued O, Marshall BD. Inclusion of trans women in pre-exposure prophylaxis trials: a review. AIDS Care. 2015;27(5):637–41.CrossRefPubMedGoogle Scholar
  4. 4.
    Deutsch MB, Glidden DV, Sevelius J, Keatley J, McMahan V, Guanira J, et al. HIV pre-exposure prophylaxis in transgender women: a subgroup analysis of the iPrEx trial. Lancet HIV. 2015;2(12):e512–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22.CrossRefPubMedGoogle Scholar
  6. 6.
    Shulden JD, Song B, Barros A, Mares-DelGrasso A, Martin CW, Ramirez R, et al. Rapid HIV resting in transgender communities by community-based organizations in three cities. Public Health Rep. 2008;123(Suppl 3):101–14.CrossRefGoogle Scholar
  7. 7.
    Sevelius JM, Keatley J, Calma N, Arnold E. ‘I am not a man’: trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health. 2016;11(7–8):1060–75.CrossRefPubMedGoogle Scholar
  8. 8.
    Meyers K, Golub SA. Planning ahead for implementation of long-acting HIV prevention: Challenges and opportunities. Curr Opin HIV AIDS. 2015;10(4):290–5.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Poteat T, Wirtz AL, Radix A, Borquez A, Silva-Santisteban A, Deutsch MB, et al. HIV risk and preventive interventions in transgender women sex workers. Lancet. 2015;385(9964):274–86.CrossRefPubMedGoogle Scholar
  10. 10.
    Dowshen N, Lee SS, Castillo M, Hawkins L, Barg FK. Barriers and facilitators to HIV prevention, testing, and treatment among young transgender women. J Adolesc Health. 2016;58(2):S81–2.Google Scholar
  11. 11.
    Safer JD, Coleman E, Feldman J, Garofalo R, Hembree W, Radix A, et al. Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabet Obes. 2016;23(2):168–71.CrossRefGoogle Scholar
  12. 12.
    Sevelius JM, Deutsch MB, Grant R. The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices. J Int AIDS Soc. 2016;19(7(Suppl 6)):21105.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Sevelius JM. Gender affirmation: a framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013;68(11):675–89.CrossRefPubMedGoogle Scholar
  14. 14.
    SFDPH. San Francisco Department of Public Health. https://www.sfdph.org/dph/default.asp (2017). Accessed 2 Apr 2017.
  15. 15.
    Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDS. 2013;27(4):248–54.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Galindo GR, Walker JJ, Hazelton P, Lane T, Steward WT, Morin SF, et al. Community member perspectives from transgender women and men who have sex with men on pre-exposure prophylaxis as an HIV prevention strategy: implications for implementation. Implement Sci. 2012;7:116.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    McGowan I, Cranston RD, Mayer KH, Febo I, Duffill K, Siegel A, et al. Project gel a randomized rectal microbicide safety and acceptability study in young men and transgender women. PLoS One. 2016;11(6):e0158310.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Trezza C, Ford SL, Spreen W, Pan R, Piscitelli S. Formulation and pharmacology of long-acting cabotegravir. Curr Opin HIV AIDS. 2015;10(4):239–45.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Dunne N. Northwestern receives $17 million grant for HIV prevention research: Northwestern Medicine: Feinberg School of Medicine. (2015). http://news.feinberg.northwestern.edu/2015/08/17-million-grant-for-hiv-prevention-research/.
  20. 20.
    aidsinfo.nih.gov. Cabotegravir: U.S. Department of Health and Human Services. (2017). https://aidsinfo.nih.gov/drugs/513/cabotegravir/0/patient.
  21. 21.
    Saldaña J. The coding manual for qualitative researchers. 2nd ed. London: Sage; 2013.Google Scholar
  22. 22.
    Greene JA, Thorogood N. Qualitative methods for health research: Third edition. Silverman D, editor. London: Sage; 2014.Google Scholar
  23. 23.
    Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27(2):237–46.CrossRefGoogle Scholar
  24. 24.
    Glidden DV, Amico KR, Liu AY, Hosek SG, Anderson PL, Buchbinder SP, et al. Symptoms, side effects and adherence in the iPrEx open-label extension. Clin Infect Dis. 2016;62(9):1172–7.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367(5):411–22.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Molina JM, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237–46.CrossRefPubMedGoogle Scholar
  28. 28.
    Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet. 2013;381(9883):2083–90.CrossRefGoogle Scholar
  29. 29.
    Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.CrossRefPubMedGoogle Scholar
  31. 31.
    Van der Elst EM, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, et al. High acceptability of HIV Pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS Behav. 2013;17(6):2162–72.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Claborn KR, Meier E, Miller MB, Leffingwell TR. A systematic review of treatment fatigue among HIV-infected patients prescribed antiretroviral therapy. Psychol Health Med. 2015;20(3):255–65.CrossRefPubMedGoogle Scholar
  33. 33.
    Dolgin E. Long-acting HIV drugs advanced to overcome adherence challenge. Nat Med. 2014;20(4):323–4.CrossRefPubMedGoogle Scholar
  34. 34.
    Markowitz M, Meyers K. Extending access with long-acting antiretroviral therapy: the next advance in HIV-1 therapeutics and prevention. Curr Opin HIV AIDS. 2015;10(4):216–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Trussell J, Wynn LL. Reducing unintended pregnancy in the United States. Contraception. 2008;77(1):1–5.CrossRefPubMedGoogle Scholar
  36. 36.
    O’Neil-Callahan M, Peipert JF, Zhao Q, Madden T, Secura G. Twenty-four-month continuation of reversible contraception. Obstet Gynecol. 2013;122(5):1083–91.CrossRefPubMedGoogle Scholar
  37. 37.
    HPTN-083. A Phase 2b/3 Double Blind Safety and Efficacy Study of Injectable Cabotegravir Compared to Daily Oral Tenofovir Disoproxil Fumarate/Emtricitabine (TDF/FTC), for Pre-Exposure Prophylaxis in HIV-Uninfected Cisgender Men and Transgender Women who have Sex with Men. https://www.hptn.org/research/studies/hptn083 (2017). Accessed 2 April 2017.
  38. 38.
    Sanchez NF, Sanchez JP, Danoff A. Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City. Am J Public Health. 2009;99(4):713–9.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Yoon R, Mooney J, Broder G, Bolton M, Votto T, Davis-Vogel A, et al. Exploring barriers and facilitators to participation of male-to-female transgender persons in preventive HIV vaccine clinical trials. Prev Sci. 2014;15(3):268–76.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Ramirez-Valles J, Molina Y, Dirkes J. Stigma towards PLWHA: the role of internalized homosexual stigma in Latino gay/bisexual male and transgender communities. AIDS Educ Prev. 2013;25(3):179–89.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Calabrese SK, Underhill K. How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: a call to destigmatize “truvada whores”. Am J Public Health. 2015;105(10):1960–4.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Wood SM, Lee S, Barg FK, Castillo M, Dowshen N. Young transgender women’s attitudes toward HIV Pre-exposure prophylaxis. J Adolesc Health. 2017;60(5):549–55.CrossRefPubMedGoogle Scholar
  43. 43.
    Sevelius JM, Patouhas E, Keatley JG, Johnson MO. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med. 2013;47(1):5–16.CrossRefGoogle Scholar
  44. 44.
    Brooks RA, Kaplan RL, Lieber E, Landovitz RJ, See SJ, Leibowitz AA. Motivators, concerns, and barriers to adoption of preexposure prophylaxis for HIV prevention among gay and bisexual men in HIV-serodiscordant male relationships. AIDS Care. 2011;23(9):1136–45.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    DOHMH. New York City Department of Health and Mental Hygiene: prevent HIV and other STIs. http://www1.nyc.gov/site/doh/health/health-topics/playsure.page (2017). Accessed 17 July 2017.
  46. 46.
    DOHMH. New York City Department of Health and Mental Hygiene: be sure, play sure, stay sure. https://www1.nyc.gov/site/doh/health/health-topics/hiv-besure-playsure-staysure.page (2017). Accessed 18 July 2017.

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

Personalised recommendations