What Encourages Black and Latinx Trans Women to Take PrEP?

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Tonia Poteat, Ph.D., courtesy of the Johns Hopkins University Center for Public Health and Human Rights

It has been a challenge to encourage transgender women of color to take and adhere over time to pre-exposure prophylaxis (PrEP). And, while HIV prevention is a priority -- especially since trans women are the most vulnerable to HIV infection -- this demographic is juggling a myriad of other issues, including gender transitioning, housing and employment security, and general safety.

But not all is lost. There are factors that can increase black and Latinx trans women's willingness to pop this little blue pill every day. At CROI 2018, Tonia Poteat, Ph.D., assistant professor of public health with John's Hopkins University, presented research on "Predictors of Willingness to Take PrEP Among Black and Latina Trans Women" to show what can work to increase PrEP uptake among this population, determine possibilities for successful interventions, and ask questions for future research.

Attentdees at CROI 2018 (Myles Helfand)

A Little Background

The team surveyed 201 black and Latinx trans women in Baltimore and Washington D.C. It conducted numerous sets of interviews to determine HIV prevalence and understand these women's own perceptions of their HIV risk, their knowledge of PrEP, and what about this biomedical prevention tool turns them off.

The researchers found that more than half (57.2%) had unstable housing in the past year, 75.8% were living below the poverty line, and 55.7% tested positive. In terms of PrEP, 86.6% were knowledgeable about it, but only 17.9% had taken PrEP in their lives. Most women in the study had insurance (mostly public insurance, such as Medicaid), so getting PrEP covered by insurance seemed to be less of a concern in this cohort.

Attentdees at CROI 2018 (Myles Helfand)

Reasons Why PrEP Isn't Always Desirable to Trans Women

In their own words, trans women of color participating in the study had some reservations about taking PrEP because they were concerned about how it would interact with their use of feminization hormones. In addition, they noted concerns about side effects or said that having to take a daily pill just wasn't something they wanted to do.

What surprised researchers, according to Poteat, was that having legal gender affirmation, such as a name and gender marker changed on a driver's license, was not associated with a risk perception for HIV, and it instead reduced willingness to take PrEP.

Tonia Poteat, Ph.D., at last year's CROI (Kenyon Farrow)

What Makes Black and Latinx Trans More Willing to Take PrEP?

Poteat found that having a history of sex work/transactional sex and perception of HIV risk were linked with a higher willingness to take PrEP among trans women of color.

However, three-fourths of black trans female participants reported both knowledge of and willingness to take PrEP, despite low uptake. So, it's clear that there is a need for PrEP; the key is understanding how to fill the gap.

Robb Cohen Photography & Video

Why Does This Matter?

Black and Latinx trans women have an incredibly high HIV prevalence rate, with past studies suggesting it's 3.2 per every 100 people. To reduce HIV rates, understanding how risk perception lowers with the changing legal documents might help create effective interventions to encourage PrEP use among trans women.

Myles Helfand

Listen to Black and Latinx Trans Women

By actually listening to these women's concerns, potentially successful interventions can be achieved. One way could be creating strategies that directly address the link between black and Latina women, sex work and transactional sex, a high perception of HIV risk, and PrEP willingness.

In addition, since trans women were deeply concerned with how PrEP might interact with their hormonal treatments, we need to push for more studies around this issue and interventions that specifically address this worry.

Myles Helfand

Finally, Understand That Gender Affirmation and PrEP Willingness Is Complicated

While it might be expected that a legal name change would increase trans women of color's PrEP willingness, it actually reduced their desire to take it. So, moving forward, we need to ask ourselves hard questions about who gender-affirmed trans women believe PrEP is for?

Also, does taking PrEP, which has been mostly marketed to men who have sex with men, somehow threaten the way trans women view their own womanhood and discourage them taking it?

Kellee Terrell is the former news editor for TheBody.com and TheBodyPRO.com. Her work has appeared in Huffington Post, Essence, Ebony, The Advocate, POZ* and the Black AIDS Institute, to name a few. Follow her on Twitter @kelleent.*