Getting pre-exposure prophylaxis to high-risk transgender women: lessons from Detroit, USA
Julia E. Hood A H , Tony Eljallad B , Julisa Abad C , Maureen Connolly D , Christine Heumann E , Jonathan Fritz F , Mary Roach F , Dawn Lukomski F and Matthew R. Golden A GA Public Health - Seattle & King County, 401 5th Avenue, Suite 1250, Seattle, WA 98104, USA.
B ACCESS, 6450 Maple Street, Dearborn, MI 48126, USA.
C Fair Michigan, 645 Griswold Avenue, Suite 4300, Detroit, MI 48226, USA.
D Henry Ford Health System, 77 Victor Street, Highland Park, MI 48203, USA.
E Department of Medicine, Division of Infectious Diseases, Wayne State University, 540 E. Canfield Street, Detroit, MI 48201, USA.
F Michigan State Department of Health and Human Services, 109 W Michigan Avenue, 10th Floor, Lansing, MI 48913, USA.
G University of Washington, Department of Medicine, 325 9th Avenue, Seattle, WA 98104, USA.
H Corresponding author. Email: julia.hood@kingcounty.gov
Sexual Health 15(6) 562-569 https://doi.org/10.1071/SH18063
Submitted: 31 March 2018 Accepted: 12 September 2018 Published: 2 November 2018
Abstract
Background: Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy, but it is unclear how best to deliver PrEP to key populations. Drawing upon a cross-sectional survey of transgender women (TW) in Detroit, USA, and experience of a PrEP clinic that serves this population, this manuscript describes the following: (1) the risk profile of Detroit TW; (2) the proportion of TW with at least one PrEP indication; and (3) perceptions of and experiences with PrEP among TW in Detroit. Methods: Between August 2017 and March 2018, 126 TW completed an online PrEP survey. Survey responses were summarised using descriptive statistics and multivariable relative risk regression. Results: Among participants who reported a negative or unknown HIV status (76% of all participants), 56% reported risk behaviour(s) consistent with PrEP indication guidelines, 17% reported currently taking PrEP and another 4% reported discontinued PrEP use. Among participants who met an indication for PrEP but were not currently taking PrEP, 64% indicated that they were not interested in taking PrEP. Approximately 60% of participants who were not currently taking PrEP reported that they would be more likely to take PrEP if it were provided at a clinic that also provided hormone replacement therapy. Conclusions: Although a substantial proportion of TW in our survey were on PrEP, interest in PrEP among high-risk TW who were not taking it was low. Specialised clinical infrastructure that is responsive to the specific needs of TW may be needed to expand PrEP to this oftentimes marginalised and high-risk population.
Additional keywords: HIV prevention, key populations, PrEP.
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