Transgender people account for an estimated 2.8% of the population in the District of Columbia (DC), however, account for approximately 2% of the population living with HIV. Among transgender people, black transgender people constitute the majority of HIV cases (83%) in DC; and of that number black transgender women account for 67% of those cases. Pre-Exposure Prophylaxis (PrEP) offers an opportunity to prevent and further limit the spread of HIV, however, uptake and adherence among black transgender women has been low. Barriers to PrEP may be driven by a variety of behavioral, clinical, service delivery, socio-cultural, and other structural challenges. However, little is known about how these factors influence PrEP uptake and adherence in black transgender women. Black transgender women are strategically important for preventing HIV on a larger scale because sexually they intersect with multiple sexual networks and are a classic bridging population to HIV infection in other key groups. Thus, there is an urgent need to identify the factors influencing uptake of preventive therapies such as PrEP and to develop strategies that will enhance the preventive strength of PrEP in this population.
Addressing the multi-level factors that increase this population’s vulnerabilities to HIV and is challenging, expensive, and not feasible over a short period of time. Therefore, the long-term goal of this research is to prevent HIV infection in black transgender women, by developing a tailored intervention that will increase PrEP uptake and adherence to PrEP. Guided by the Modified Social Ecological Model (MSEM), this study aims to explore black transgender women’s perspectives of barriers and facilitators to PrEP uptake and to elicit their recommendations for strategies to improve engagement in PrEP care. This study will provide formative data that will enhance our understanding of the PrEP-related barriers and needs and factors contributing to this population’s difficulty engaging in and sustaining HIV preventive care. Findings from this formative work will guide selection of specific factors or measures that are relevant to the development and pilot testing of an intervention to increase PrEP use and adherence in this population.