O15.2 ‘It’s behaviors; It’s not identity’: Attitudes Related to HIV Risk and Pre-Exposure Prophylaxis Among Transgender Women in the Southeastern US

Background Transgender women (TGW) are significantly impacted by HIV in the Southeastern U.S., where HIV prevalence is the highest in the nation. Uptake of HIV Pre-Exposure Prophylaxis (PrEP) is low among TGW nationwide. We aimed to explore barriers to PrEP awareness and uptake among TGW in the Southeastern U.S. Methods HIV-negative TGW ≥18 years old in Alabama participated in virtual focus groups (FGs) exploring barriers and beliefs related to HIV risk and PrEP among TGW in the Southeastern U.S. Participants were recruitment via social media, community outreach, and financial incentives to participants for referrals. A trained qualitative researcher coded transcripts after each FG and iteratively amended the FG protocol as new themes emerged. Results Between July 2020 and December 2020, 17 TGW participated in 4 FGs. Mean participant age was 28.1±8.5 years. Black, non-Hispanic and white, non-Hispanic TGW represented 41% (n=7) and 47% (n=8) of participants, respectively. Fifteen participants had heard of PrEP but only one had ever taken PrEP. Participants identified several barriers to PrEP use, including frustration regarding the conflation of transgender identity and HIV risk, lack of appropriate transgender representation in PrEP advertising, concerns for drug-drug interactions between PrEP and hormone replacement therapy, the perception that PrEP is primarily meant for cisgender men who have sex with men, and limited trans-affirming healthcare resources. Participants expressed that sexual risk behaviors, rather than transgender identity, should be central to healthcare providers’ discussion of PrEP with TGW. Conclusion Nuanced messaging from healthcare providers and media is necessary to properly educate and engage TGW in HIV prevention strategies such as PrEP. A one-size-fits-all approach is inappropriate given the diversity among TGW regarding sexual behaviors and HIV risk factors. Discussions between TGW and healthcare providers should focus on individual HIV risk and patient concerns when determining whether or not PrEP is appropriate.