Barriers and facilitators to PrEP for transwomen in Brazil

ABSTRACT

Pre-exposure prophylaxis (PrEP) is an important biomedical intervention that may help reduce the risk of HIV transmission among transwomen. To date, little research is available to inform interventions to increase uptake and adherence to PrEP among transwomen, especially in places outside the U.S. We conducted a qualitative study in 2015 with 34 adult transwomen in Rio de Janeiro, Brazil and assessed awareness, interest, barriers and facilitators to PrEP uptake and adherence for transwomen. Almost one third of participants had heard of PrEP, and most were interested and thought it would be beneficial for transwomen in their community. Barriers to PrEP included fear of being HIV positive resulting in low HIV testing and concerns about the ability to adhere to a daily PrEP regimen. The most prominent barrier to uptake was past experiences of transgender-identity related discrimination in the universal health care system that reduced willingness to seek PrEP or health care in general. Participants recommended technological solutions to PrEP health education information that could address uptake and adherence. This study informs efforts to increase PrEP use among transwomen in Brazil.

KEYWORDS:

• Pre exposure prophylaxis
• transgender women
• HIV prevention
• Brazil

Acknowledgements

We would like to honour and thank all the transwomen that participated in this study who shared so much about their personal lives and experiences. Without these insights, there would be little information from which to develop and implement PrEP interventions for transwomen in Brazil, and so we thank them for their community service as well.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Erin C. Wilson http://orcid.org/0000-0002-0237-495X

Additional information

Funding

This study was funded by the Brazilian Research Council (National Council for Scientific and Technological Development [470056/2014-2]) and Division of Intramural Research, National Institute of Allergy and Infectious Diseases (National Institutes of Health [UM1AI069496]).