A Promising PrEP Navigation Intervention for Transgender Women and Men Who Have Sex with Men Experiencing Multiple Syndemic Health Disparities
Transgender women and MSM experience many stigma-related syndemic conditions that exacerbate HIV incidence and prevalence rates. While PrEP is an effective biomedical intervention to reduce HIV transmission, uptake and adherence of PrEP is low among transgender women and MSM experiencing multiple syndemic health disparities. This study tested the feasibility, acceptability and effectiveness of A.S.K.-PrEP (AssistanceServicesKnowledge-PrEP), a five-session peer navigator program, designed to link transgender women and MSM to PrEP. From September 2016 to March 2018, 187 participants (transgender women = 58; MSM = 129) enrolled. Results demonstrated that approximately 90% of transgender women and MSM were linked to PrEP; MSM linked more quickly [KW χ2(1) = 10.9, p < .001]. Most transgender women (80%) and MSM (70%) reported they were still taking PrEP at the 90-day follow-up evaluation. Findings indicated that A.S.K.-PrEP is a promising intervention for PrEP linkage, uptake and preliminary adherence among transgender women and MSM.
KeywordsPrEP HIV prevention Transgender MSM Health disparities
This program was supported by the California Department of Public Health (CDPH), Center for Infectious Diseases, Office of AIDS, #15-11045. Drs. Reback and Fehrenbacher acknowledge additional support from the National Institute of Mental Health, #P30 MH58107. Dr. Fehrenbacher acknowledges additional support from the University of California, Los Angeles and the National Institute of Mental Health, #T32 MH109205.
Compliance with Ethical Standards
Conflict of interest
No potential conflict of interest was reported by the authors.
- 1.Centers for Disease Control and Prevention. (2017). Fact sheet: HIV among gay and bisexual men. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/hiv/group/msm/index.html.
- 3.Centers for Disease Control and Prevention. (2017). Fact sheet: HIV among transgender people. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/hiv/group/gender/transgender/index.html.
- 9.Reback, C. J., & Fletcher, J. B. (2017). Outcomes from a homegrown HIV prevention program for extremely high-risk, substance-using men who have sex with men with multiple health disparities. Journal of Gay & Lesbian Social Services, 29(2), 167–181.Google Scholar
- 17.Huang, X., Hou, J., Song, A., et al. (2018). Efficacy and safety of oral TDF-based pre-exposure prophylaxis for men who have sex with men: A systematic review and meta-analysis. Frontiers in pharmacology, 9(799), 1–11.Google Scholar
- 20.Spinner, C. D., Boesecke, C., Zink, A., et al. (2016). HIV pre-exposure prophylaxis (PrEP): A review of current knowledge of oral systemic HIV PrEP in humans. Infection, 44(2), 151–158.Google Scholar
- 30.Centers for Disease Control and Prevention. (2018). HIV prevention pill not reaching most Americans who could benefit: Especially people of color. Press release. National center for HIV/AIDS, viral Hepatitis, STD, and TB prevention. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/nchhstp/newsroom/2018/croi-2018-PrEP-press-release.html.
- 31.Conference on Retroviruses and Opportunistic Infections (CROI). (2018). PrEP at CROI 2018 report 2: Uptake, HIV incidence, barriers/challenges. Report from Conference on Retroviruses and Opportunistic Infections (CROI), Boston, MA.Google Scholar
- 35.Arnold, E. A., Hazelton, P., Lane, T., Christopoulos, K. A., Galindo, G. R., Steward, W. T., et al. (2012). A qualitative study of provider thoughts on implementing pre-exposure prophylaxis (PrEP) in clinical settings to prevent HIV infection. PLoS ONE, 7(7), e40603.PubMedPubMedCentralGoogle Scholar
- 38.Hosek, S., Celum, C., Wilson, C. M., Kapogiannis, B., Delany-Moretlwe, S., & Bekker, L. G. (2016). Preventing HIV among adolescents with oral PrEP: Observations and challenges in the United States and South Africa. Journal of the International AIDS Society, 19, 21107.PubMedPubMedCentralGoogle Scholar
- 41.Pathela, P., Jamison, K., Blank, S., et al. (2018). The PREP cascade at NYC sexual health clinics: Navigation is the key to uptake, in Presented at: Conference on Retroviruses and Opportunistic Infections (CROI), Boston, MA.Google Scholar
- 42.Turner, R. J., & Turner, J. B. (1999). Social integration and support. Handbook of the sociology of mental health (pp. 301–319). Boston, MA: Springer.Google Scholar
- 43.Veiel, H. O., & Baumann, U. (2014). The meaning and measurement of support. Abingdon: Taylor & Francis.Google Scholar
- 45.Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50(2), 248–287.Google Scholar
- 47.Golub, S. A., Gamarel, K. E., Rendina, H. J., Surace, A., & Lelutiu-Weinberger, C. L. (2013). From efficacy to effectiveness: Facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care and STDs, 27(4), 248–254.PubMedPubMedCentralGoogle Scholar
- 52.Reback, C. J., Fletcher, J. B., Swendeman, D. A., & Metzner, M. (2019). Theory-based text-messaging to reduce methamphetamine use and HIV sexual risk behaviors among men who have sex with men: Automated unidirectional delivery outperforms bidirectional peer interactive delivery. AIDS and Behavior, 23(1), 37–47.PubMedPubMedCentralGoogle Scholar
- 55.Baams, L., Jonas, K. J., Utz, S., Bos, H. M., & Van Der Vuurst, L. (2011). Internet use and online social support among same sex attracted individuals of different ages. Computers in Human Behavior, 27(5), 1820–1827.Google Scholar
- 61.Garcia, J., Colson, P. W., Parker, C., & Hirsch, J. S. (2015). Passing the baton: Community-based ethnography to design a randomized clinical trial on the effectiveness of oral pre-exposure prophylaxis for HIV prevention among black men who have sex with men. Contemporary Clinical Trials, 45, 244–251.PubMedPubMedCentralGoogle Scholar
- 63.Seelman, K. L., Colón-Diaz, M. J., LeCroix, R. H., Xavier-Brier, M., & Kattari, L. (2017). Transgender noninclusive healthcare and delaying care because of fear: Connections to general health and mental health among transgender adults. Transgender Health, 2(1), 17–28.PubMedPubMedCentralGoogle Scholar
- 65.Hughto, J. M. W., Reisner, S. L., & Pachankis, J. E. (2015). Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social Science and Medicine, 147, 222–231.Google Scholar
- 67.Dowshen, N., Kuhns, L. M., Johnson, A., Holoyda, B. J., & Garofalo, R. (2012). Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: A pilot study using personalized, interactive, daily text message reminders. Journal of Medical Internet Research, 14(2), e51.PubMedPubMedCentralGoogle Scholar
- 68.Reback, C. J., Ruenger, D., Fletcher, J., et al. (2019). Text messaging to promote advancement along the HIV care continuum among young transgender women living with HIV, in Presented at: National HIV Prevention Conference, Atlanta, GA.Google Scholar