Barriers to Accessing and Engaging in HIV Preventive Care and Pre-Exposure Prophylaxis Experienced by Transgender Women in Florida

Authors

Allysha C. Maragh-Bass, Global Health and Population Division, FHI 360, Durham, NC 27701, USA.
Sandra Kiplagat, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA.
Sarah Lavari, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA.
Francisco Sastre, Department of Psychology, Carlos Albizu University, Miami, FL 33172, USA.
Jessy G. Devieux, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA.
Daniel Jimenez, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA.
Rachel D. Clarke, Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA.
Ines Noel, Department of Psychology, College of Arts and Science, New York University, New York City, NY 10003, USA.
Eric W. Schrimshaw, Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL 32827, USA.
Jae Sevelius, Department of Prevention Science, University of California, San Francisco, CA 94158, USA.
Elena Cyrus, Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL 32827, USA.

Document Type

Journal Article

Publication Date

3-21-2024

Journal

International journal of environmental research and public health

Volume

21

Issue

3

DOI

10.3390/ijerph21030376

Keywords

Florida; HIV; PrEP; barriers to care; transgender women

Abstract

BACKGROUND: PrEP, a biomedical HIV prevention option, continues to be underutilized among transgender women who could benefit from sustained use, especially women of color and those who identify as Latina and/or reside in the southeastern US. OBJECTIVE: We explored the barriers and facilitators experienced by transgender women who live in Florida regarding accessing, using, and/or staying on PrEP. METHODS: In-depth interviews and focus groups were conducted in either Spanish or English with adult transgender women living in Florida (N = 22). The interviews were audio-recorded, transcribed, and coded in ATLAS.ti using thematic analyses. RESULTS: The mean age of the participants was 42.2 years. Among the participants, 73% were Hispanic/Latina, 59% were foreign-born, and approximately one-third were living with HIV (but had past experience with PrEP). Transgender women cited the following barriers to accessing or considering PrEP: (1) costs and benefits of PrEP use; (2) under-representation in clinical trials resulting in unknown or misinformation regarding PrEP side effects; (3) chronic poverty; and (4) trauma and discrimination. Other stressors, such as behavioral healthcare needs, were identified. CONCLUSIONS: Our analysis revealed interlocking systems of oppression like transphobia, discrimination, and misgendering, which were common barriers experienced by our participants. These synergistically epidemic (i.e., syndemic) barriers contributed to their feelings of being systematically excluded in social spaces, research, public health planning and policies, laws, and social programs related to PrEP. These structural barriers are impediments to HIV preventive care but also act as a source of stress that contributes to mental health problems, financial vulnerability, substance abuse, and other deleterious health outcomes.

APA Citation

Maragh-Bass, Allysha C.; Kiplagat, Sandra; Lavari, Sarah; Sastre, Francisco; Devieux, Jessy G.; Jimenez, Daniel; Clarke, Rachel D.; Noel, Ines; Schrimshaw, Eric W.; Sevelius, Jae; and Cyrus, Elena, "Barriers to Accessing and Engaging in HIV Preventive Care and Pre-Exposure Prophylaxis Experienced by Transgender Women in Florida" (2024). GW Authored Works. Paper 4494.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4494

Department

School of Medicine and Health Sciences Student Works