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RESEARCH ARTICLE
Contents Vol 21(1)

Lived experiences with pre-exposure prophylaxis uptake and adherence among transgender women in Thailand: a qualitative study

Rena Janamnuaysook https://orcid.org/0000-0002-8054-482X A B , Yan Guo C , Yeon Jung Yu D , Nittaya Phanuphak https://orcid.org/0000-0002-0036-3165 A B , Surinda Kawichai E , Karen MacDonell F , Thidarat Jupimai E , Chokechai Rongkavilit G and Bo Wang https://orcid.org/0000-0001-5132-7685 H *
+ Author Affiliations
- Author Affiliations

A Institute of HIV Research and Innovation, Bangkok, Thailand.

B Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand.

C Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.

D Department of Anthropology, Western Washington University, Bellingham, WA, USA.

E Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand.

F Center for Translational Behavioral Research, Florida State University, Tallahassee, FL, USA.

G Department of Pediatrics, University of California San Francisco-Fresno Branch Campus, Fresno, CA, USA.

H Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.

* Correspondence to: Bo.Wang@umassmed.edu

Handling Editor: Heather Armstrong

Sexual Health 21, SH23102 https://doi.org/10.1071/SH23102
Submitted: 9 June 2023  Accepted: 16 December 2023  Published: 15 January 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing

Abstract

Background

Transgender women (TGW) are disproportionately affected by HIV, and HIV prevalence among TGW in Thailand has been increasing. Although oral daily pre-exposure prophylaxis (PrEP) is effective for HIV prevention, PrEP uptake and persistence among TGW have been low. This study aimed to provide a deeper understanding of TGW’s experiences with PrEP uptake and adherence, and to identify major barriers to PrEP use to inform intervention adaptation.

Methods

We interviewed 20 young TGW (six non-PrEP users, eight adherent, six non-adherent) and 10 health care providers from two HIV clinics in Bangkok, Thailand, in 2022. We focused on understanding challenges to PrEP use in this population using an interview guide based on a theoretical model of behaviour change and thematic content analysis.

Results

Thematic analysis identified major barriers to and facilitators of PrEP uptake and adherence. Barriers to PrEP initiation included low self-perceived HIV risk, concern about potential side-effects, patient burdens such as frequent HIV testing for prescription refills and social stigma against PrEP. Barriers to adherence included side-effects, inconvenient access to health services (especially during COVID-19 lockdowns), forgetfulness resulting from busy schedules and low self-perceived HIV risk. TGW also reported health care providers’ stigma against PrEP users deterred them from seeking further PrEP services. TGW identified major facilitators of PrEP initiation, including awareness about the benefits of PrEP, concern about risks of HIV and supportive social networks of PrEP users. As to PrEP regimens, most TGW participants reported a clear preference for long-lasting, injectable PrEP over daily oral PrEP. TGW and health care providers largely agreed on barriers and facilitators of PrEP use, but they differed in perceptions of HIV risk.

Conclusions

The results highlighted challenges and opportunities to improve the delivery of PrEP, as well as other sexually transmissable infection and mental health services, especially among TGW. Thus, there is an urgent need for developing effective intervention programs that could raise PrEP awareness and knowledge, reduce PrEP stigma, and improve PrEP delivery systems among TGW in Thailand.

Keywords: adherence, barriers, facilitators, HIV prevention, in-depth interview, pre-exposure prophylaxis, PrEP uptake, Thailand, transgender women.

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