The association between healthcare system interactions and PrEP usage among transgender and gender nonconforming adults in Massachusetts and Rhode Island

Rofe, Kara

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Year:: 2022
Contributor:: Rofe, Kara (creator); Pearlman, Deborah (Reader); Hughto, Jaclyn (Advisor); Brown University. School of Public Health (sponsor)
Genre:: theses
Subject:: Pre-exposure prophylaxis; Medicine, Preventive; Preventive health services; Transgender people; LGBT health; Sexual minorities
Extent:: v, 28 p.

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Abstract:: Background: Transgender and gender nonconforming (TGNC) adults are disproportionately impacted by HIV. Despite the high efficacy of pre-exposure prophylaxis (PrEP) to prevent HIV, research suggests that PrEP is underutilized among TGNC people. Research is needed to identify which subgroups of at-risk TGNC people are not utilizing PrEP. Methods: In 2019, a survey assessing PrEP knowledge and use, healthcare experiences, sexual risk behavior and demographics was administered to 600 TGNC adults in Massachusetts and Rhode Island in-person and online. For the current analysis, the sample was restricted to HIV-negative individuals who had reported one or more HIV risk behaviors, including having sexual contacts with six or more people in the past 6 months, engaging in condomless sex in the past 6 months, having a lifetime history of STIs, and engaging in sex work in the past year, resulting in an analytic sample of n=166. An age-adjusted multivariable logistic regression model tested the association between condomless sex in the past 6 months, lifetime history of STIs, accessing HIV prevention services in the past 12 months and the outcome: lifetime non-utilization of PrEP. Findings: The mean age of this high HIV-risk sample of TGNC adults was 30.8 years old (SD=10.0) and 81.9% were White non-Hispanic. Overall, 31.3% were trans feminine, 24.7% were trans masculine, and 44.0% were non-binary. PrEP awareness was high (80.7%) but few had a history of taking PrEP (14.5%). In the age-adjusted multivariable model, not accessing HIV prevention services in the past 12 months months (aOR=21.14, 95% CI=6.43, 69.49), never having an STI (aOR=3.10, 95% CI= 1.02, 9.39), and engaging in condomless anal or vaginal sex in the past 6 months (aOR=3.84, 95% CI= 1.12, 13.14) were associated with the increased odds of never having used PrEP. Conclusion: This study represents the first to our knowledge to quantitatively assess factors associated with not using PrEP in a multistate sample of TGNC adults who are HIV negative and at-risk for the virus. The findings extend a body of evidence documenting the lack of PrEP usage among TGNC adults. The low number of at-risk TGNC people who used PrEP indicates the need for structural and clinical interventions to increase PrEP access among this population.
Notes:: Thesis (M. P. H.)--Brown University, 2022

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Citation

Rofe, Kara, "The association between healthcare system interactions and PrEP usage among transgender and gender nonconforming adults in Massachusetts and Rhode Island" (2022). Public Health Theses and Dissertations. Brown Digital Repository. Brown University Library. https://repository.library.brown.edu/studio/item/bdr:jp6v2s4k/

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Public Health Theses and Dissertations

Theses and Dissertations for the Public Health department.
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