Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building 155 College Street, Toronto, ON, M5T 3M7, Canada.
Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.
BMC Public Health. 2024 Jul 25;24(1):1985. doi: 10.1186/s12889-024-19474-x.
Oral pre-exposure prophylaxis (PrEP) for HIV-1 infection is over 99% effective in protecting against HIV acquisition when used consistently and appropriately. However, PrEP uptake and persistent use remains suboptimal, with a substantial gap in utilization among key populations who could most benefit from PrEP. In Latin America specifically, there is poor understanding of barriers to PrEP uptake and persistence among transgender (trans) women.
In April-May 2018, we conducted qualitative interviews lasting 25-45 min as part of an end-of-project evaluation of TransPrEP, a pilot RCT that examined the impact of a social network-based peer support intervention on PrEP adherence among trans women in Lima, Peru. Participants in the qualitative evaluation, all adult trans women, included individuals who either (1) screened eligible to participate in the TransPrEP pilot, but opted not to enroll (n = 8), (2) enrolled, but later withdrew (n = 6), (3) were still actively enrolled at the time of interview and/or successfully completed the study (n = 16), or (4) were study staff (n = 4). Interviews were audio recorded and transcribed verbatim. Codebook development followed an immersion/crystallization approach, and coding was completed using Dedoose.
Evaluation participants had a mean age of 28.2 years (range 19-47). When describing experiences taking PrEP, participant narratives highlighted side effects that spanned three domains: physical side effects, such as prolonged symptoms of gastrointestinal distress or somnolence; economic challenges, including lost income due to inability to work; and social concerns, including interpersonal conflicts due to HIV-related stigma. Participants described PrEP use within a broader context of social and economic marginalization, with a focus on daily survival, and how PrEP side effects negatively contributed to these stressors. Persistence was, in some cases, supported through the intervention's educational workshops.
This research highlights the ways that physical, economic, and social side effects of PrEP can impact acceptability and persistence among trans women in Peru, amplifying and layering onto existing stressors including economic precarity. Understanding the unique experiences of trans women taking PrEP is crucial to informing tailored interventions to improve uptake and persistence.
在正确且持续使用的情况下，HIV-1 感染的口腔暴露前预防（PrEP）对预防 HIV 感染的有效率超过 99%。然而，PrEP 的使用率和持续使用率仍然不理想，在最能受益于 PrEP 的关键人群中，利用程度存在巨大差距。特别是在拉丁美洲，人们对跨性别（trans）女性接受和持续使用 PrEP 的障碍了解甚少。
在 2018 年 4 月至 5 月，我们进行了定性访谈，每次访谈持续 25-45 分钟，作为秘鲁利马 TransPrEP 试点随机对照试验结束项目评估的一部分。定性评估的参与者均为成年跨性别女性，包括以下几类：（1）筛查合格但选择不参加 TransPrEP 试点的人（n=8）；（2）已登记，但后来退出的人（n=6）；（3）在访谈时仍在积极登记和/或成功完成研究的人（n=16）；或（4）研究人员（n=4）。访谈内容进行了录音和逐字转录。编码簿的开发遵循沉浸/结晶方法，使用 Dedoose 完成编码。
评估参与者的平均年龄为 28.2 岁（范围 19-47 岁）。在描述服用 PrEP 的经历时，参与者的叙述突出了三个方面的副作用：身体副作用，例如胃肠道不适或嗜睡等症状持续时间延长；经济挑战，包括因无法工作而导致的收入损失；以及社会问题，包括因 HIV 相关耻辱感而导致的人际关系冲突。参与者将 PrEP 的使用置于社会和经济边缘化的更广泛背景下，重点关注日常生存，以及 PrEP 的副作用如何对这些压力源产生负面影响。在某些情况下，干预措施的教育研讨会支持 PrEP 的持续使用。
这项研究强调了 PrEP 的身体、经济和社会副作用如何影响秘鲁跨性别女性对 PrEP 的可接受性和持续性，这些副作用加剧和增加了现有的压力源，包括经济不稳定。了解跨性别女性服用 PrEP 的独特经历对于制定有针对性的干预措施以提高接受率和持续率至关重要。
