Awareness, willingness and PrEP eligibility among transgender women in Rio de Janeiro, Brazil

Background: HIV epidemics disproportionately affect transwomen worldwide. Trans-specific guidance, outreach, and interventions to increase pre-exposure prophylaxis (PrEP) use among transwomen are scarce. Setting: Rio de Janeiro, Brazil. Methods: We measured awareness and willingness to use PrEP and examined factors associated with those outcomes among transwomen in Rio de Janeiro, and estimated how many transwomen would be eligible for PrEP. Data originate from Transcender study, a respondent-driven sampling survey conducted from August 2015 to January 2016. We performed regression models for PrEP awareness and willingness. Results: 131 (38.0%) out of 345 participants had heard of PrEP. Among transwomen who selfreported as HIV-negative, 162 (76.4%) out of 212 (with available data) reported willingness to use it and 163 (66.8%) out of 244 met behavioral eligibility criteria for PrEP. Transwomen with health access in the prior six months, who reported HIV-infected sexual partner, and with 8+ years of schooling had increased odds of PrEP awareness. Lower PrEP awareness was associated with condomless anal intercourse and a newly diagnosed HIV-infection. Younger age and perceiving themselves at risk of HIV-infection increased the odds of PrEP willingness. Lower odds of PrEP willingness was associated with concerns about long-term effects of PrEP and with difficulties in getting access to health care due to transphobia. Conclusion: Combination of low awareness, high willingness and substantial PrEP eligibility corroborates transwomen as a key-population for HIV prevention. PrEP is a promising and empowering strategy for HIV prevention among transwomen, but trans-specific recommendations are needed to effectively implement PrEP in this population.