Increasing PrEP Use in High-Risk Social Networks of African American MSM in Underserved Low-Uptake Cities

摘要 变性人妇女--特别是少数民族变性人妇女--艾滋病毒的流行率远远超过 比美国任何其他人口群体都要高。近三分之二的变性人女性遇到 CDC关于暴露前预防(PrEP)适应症的标准，但只有5%的人报告曾服用过PrEP。最早的 艾滋病毒预防研究将变性女性和有性行为的男性归为一类 男性(MSM)，尽管这些性少数和性别少数(SGM)群体可能面临不同的生活 挑战和需求大相径庭。除了少数几个大范围的小焦点小组研究 在东西海岸的城市中，很少有研究系统地探索导致低收入的因素 变性人妇女中接触艾滋病毒感染的高危人群使用准备剂并确定增加的方法 准备采用和持续使用。这份提案是为了回应公告OD-20-032而提交的，它要求 SGM行政补助金，将少数族裔变性人妇女的样本添加到父母津贴R01- NR017574，一个测试在密尔沃基市非裔美国MSM中增加PrEP使用量的方法的项目 和克利夫兰，这两个中西部城市的艾滋病毒差距都很明显。增刊将采用混合方法 研究设计包括60名高危少数族裔变性人，她们将从社区招募 添加到父级拨款中。在学习访问期间，每个女性都将参加一个半结构化的深入 访谈以引起对PrEP的看法、理解和信念；PrEP使用的担忧和障碍； 促进采用和持续使用PrEP的因素；关于PrEP交付的偏好 医疗模式和服务准入。采访将深入探讨如何将PrEP展示给 一种肯定积极、健康和自豪的性别认同感的方法，这种认同感可以抵消有害的 交错柱头的影响。将对深度访谈进行录音、转录、编码和定性 分析以确定如何最好地优化和量身定制干预措施，以达到并受益于艾滋病毒预防和 变性人妇女的健康需求。参与者还将接受正在使用的措施的管理 在评估艾滋病毒检测和健康史、性行为、物质使用和PrEP使用的父母赠款中 知识、态度、行为意图、规范认知和自我效能感，以及 性别少数压力和韧性在变性人和性别不一致的人中得到验证。这些 将对量化数据进行分析，以确定是否以及如何满足少数族裔的艾滋病毒预防需求 变性女性不同于少数族裔男男性行为者以及促进或阻碍PrEP的因素 在变性女性中使用。这项研究的发现将提高该领域对艾滋病毒健康的理解 跨性别少数族裔妇女的需求--一个弱势、未得到充分研究和服务的特别性别平等社区 人口--并将为实现消灭艾滋病毒国家计划的目标的执行工作提供信息 流行病。

Abstract Transgender women—especially racial minority transgender women—have HIV prevalence that is far higher than any other population segment in the United States. Nearly two-thirds of transgender women meet CDC criteria for pre-exposure prophylaxis (PrEP) indication but only 5% report ever taking PrEP. Most prior HIV prevention research has lumped together transgender women in a single category with men who have sex with men (MSM) even though these sexual and gender minority (SGM) groups may face different life challenges and have very different needs. Except for a handful of small focus group studies conducted in large cities on the East and West coasts, very little research has systematically explored factors responsible for low PrEP use among transgender women at high risk for contacting HIV infection and identified ways to increase PrEP adoption and sustained use. This proposal—submitted in response to Notice OD-20-032—requests an SGM administrative supplement to add a sample of racial minority transgender women to parent grant R01- NR017574, a project that tests approaches to increase PrEP use among African American MSM in Milwaukee and Cleveland, both Midwestern cities with stark HIV disparities. The supplement will employ a mixed-methods research design with 60 high-risk racial minority transgender women recruited from the community who will be added to the parent grant. During study visits, each woman will participate in a semi-structured in-depth interview to elicit perceptions, understandings, and beliefs about PrEP; concerns and barriers to PrEP use; factors that would facilitate the adoption and sustained use of PrEP; and preferences about PrEP delivery modalities and service access. Interviews will delve into how PrEP can be presented to transgender women in ways that affirm a positive, healthful, and proud sense of gender identity that counteracts the deleterious influence of intersectional stigma. In-depth interviews will be recorded, transcribed, coded, and qualitatively analyzed to identify how best to optimize and tailor interventions to reach and benefit the HIV prevention and health needs of transgender women. Participants will also be administered measures that are being employed in the parent grant to assess HIV testing and health history, sexual practices, substance use, and PrEP use knowledge, attitudes, behavioral intentions, norm perceptions, and self-efficacy, as well as a measure of gender minority stress and resilience validated with transgender and gender nonconforming persons. These quantitative data will be analyzed to identify whether—and how—the HIV prevention needs of racial minority transgender women differ from those of racial minority MSM as well as factors that facilitate or impede PrEP use among transgender women. Findings of this research will improve the field’s understanding of HIV health needs of transgender minority women—a vulnerable, understudied, and underserved SGM community population—and will inform implementation efforts to achieve the goals of the National Plan to End the HIV epidemic.