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Gender-Based Violence and Post-traumatic Stress Disorder Symptoms Predict HIV PrEP Uptake and Persistence Failure Among Transgender and Non-binary Persons Participating in a PrEP Demonstration Project in Southern California

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Abstract

Gender-based violence (GBV) against transgender and nonbinary (TGNB) persons is a pervasive public health issue. GBV has been linked to mental health problems such as depression and posttraumatic stress disorder (PTSD), as well has risk for HIV seroconversion and HIV treatment nonadherence. However, the impact of GBV on HIV pre-exposure prophylaxis (PrEP) use among TGNB persons has yet to be investigated. In the current study we assessed longitudinal PrEP persistence data from dried blood spots (DBS) collected from 172 racially and ethnically diverse TGNB participants during a 48-week PrEP demonstration project in Southern California from June 2017 to September 2020. Participants were categorized into three levels of PrEP uptake and persistence based on their PrEP levels at the start and end of the study: low–low, high–low, and high–high. Individual-, social-, and structural-level variables were then entered into multinomial logistic regression models to predict levels of PrEP uptake and persistence based on hypotheses informed by syndemic and minority stress theories. The models demonstrated that experience of GBV predicted significantly lower odds of PrEP uptake and persistence and greater PTSD symptoms predicted significantly greater odds of early PrEP discontinuation. Higher levels of coping skills, already being on PrEP at baseline, and being in a steady relationship were associated with greater odds of PrEP uptake and persistence. Implications for future GBV research, advocacy, interventions, and much needed structural changes focused on improving the health and safety of TGNB individuals are discussed.

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Acknowledgements

This project was funded by Grant R21DA044073 (PI: Storholm) from the National Institute on Drug Abuse. Dr. Storholm acknowledges additional support from the National Institute of Mental Health (R01MH126762; P30MH58107). Dr. Morris was funded by the parent study PrEP Linkage, Adherence & Pharmacology in Transgender Persons (PR15-SD-021) from the California HIV/AIDS Research Program. Findings from this study have informed Strategies for Implementing PrEP Services in a Trans Community Center a California HIV/AIDS Research Program-funded project (H21IS3484; PI Storholm) that is currently implementing culturally appropriate, comprehensive, and gender affirming PrEP services at the Los Angeles Trans Wellness Center. The authors would like to thank the participants of the study as well as Chloe Opalo, Alvy Rangel, and Andrew Stieber without whom this study would not have been possible.

Funding

This work was supported by National Institute on Drug Abuse (Grant No. R21DA044073), National Institute of Mental Health (Grant Nos. P30MH58107, R01MH126762), California HIV/AIDS Research Program (Grant Nos. H21IS3484, PR15-SD-021).

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Authors and Affiliations

  1. School of Public Health, San Diego State University, San Diego, CA, USA

    Erik D. Storholm

  2. RAND Corporation, Santa Monica, CA, USA

    Erik D. Storholm, Wenjing Huang & Adedotun Ogunbajo

  3. Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Erik D. Storholm & Cathy J. Reback

  4. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA

    Adedotun Ogunbajo

  5. Department of Psychology, San Diego State University, San Diego, CA, USA

    Keith J. Horvath

  6. Friends Research Institute, Los Angeles, CA, USA

    Cathy J. Reback

  7. AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA

    Jill Blumenthal, David J. Moore & Sheldon R. Morris

  8. Los Angeles LGBT Center, Los Angeles, CA, USA

    Risa P. Flynn & Robert K. Bolan

  9. Lundquist Institute, Torrance, CA, USA

    Katya C. Corado

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Correspondence to Erik D. Storholm.

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Storholm, E.D., Huang, W., Ogunbajo, A. et al. Gender-Based Violence and Post-traumatic Stress Disorder Symptoms Predict HIV PrEP Uptake and Persistence Failure Among Transgender and Non-binary Persons Participating in a PrEP Demonstration Project in Southern California. AIDS Behav 27, 745–759 (2023). https://doi.org/10.1007/s10461-022-03807-1

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