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“When Somebody Comes into This Country and You Are Trans on Top of That Is Like You Got… Two Strikes on You”: Intersectional Barriers to PrEP Use Among Latina Transgender Women in the Eastern and Southern United States

Author

Listed:
  • Rodrigo A. Aguayo-Romero

    (The Institute for Health Research & Policy at Whitman Walker, Washington, DC 20009, USA)

  • Genesis Valera

    (The Fenway Institute, Fenway Health, Boston, MA 02215, USA
    Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA)

  • Erin E. Cooney

    (Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA)

  • Andrea L. Wirtz

    (Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA)

  • Sari L. Reisner

    (Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA)

Abstract

In the United States (U.S.), Latina transgender women (LTW) are highly burdened by HIV and are prioritized for pre-exposure prophylaxis (PrEP). This study explored intersectional barriers and facilitators to PrEP uptake among LTW. Between February–November 2022, in-depth interviews were conducted with 27 LTW in the LITE Study. Participants were purposively sampled from 196 LTW in the cohort based on PrEP uptake (PrEP-naïve n = 8, PrEP-eligible and not user n = 5, current PrEP user n = 6, previous PrEP user n = 8). We conducted content analysis guided by a Modified Social Ecological Model and Intersectionality Framework. The mean age of participants was 32.3 (SD = 12.9). Themes were: (1) Intrapersonal: Medical distrust, acceptability of PrEP modalities, and concerns about long-term health; (2) Interpersonal: Mistreatment in healthcare, discrimination-related healthcare avoidance, difficulty finding trans-competent providers, language barriers, and shame and stigma; and (3) Structural: PrEP in the context of limited access to gender-affirming care and widespread silicone use, immigration status, economic marginalization, lack of community outreach, transphobia and anti-transgender legislative contexts, and xenophobia. This study found multilevel intersectional barriers influence PrEP uptake and persistence. Culturally tailored HIV prevention efforts are needed to address LTW-specific barriers, provide information on programs subsidizing PrEP, and implement policy change to ensure equitable PrEP access.

Suggested Citation

  • Rodrigo A. Aguayo-Romero & Genesis Valera & Erin E. Cooney & Andrea L. Wirtz & Sari L. Reisner, 2025. "“When Somebody Comes into This Country and You Are Trans on Top of That Is Like You Got… Two Strikes on You”: Intersectional Barriers to PrEP Use Among Latina Transgender Women in the Eastern and Sout," IJERPH, MDPI, vol. 22(5), pages 1-20, April.
    • Handle: RePEc:gam:jijerp:v:22:y:2025:i:5:p:659-:d:1639894
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    References listed on IDEAS

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    1. Bowleg, L., 2012. "The problem with the phrase women and minorities: Intersectionality-an important theoretical framework for public health," American Journal of Public Health, American Public Health Association, vol. 102(7), pages 1267-1273.
    2. White Hughto, Jaclyn M. & Reisner, Sari L. & Pachankis, John E., 2015. "Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions," Social Science & Medicine, Elsevier, vol. 147(C), pages 222-231.
    3. Sarah E Stutterheim & Mart van Dijk & Haoyi Wang & Kai J Jonas, 2021. "The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 16(12), pages 1-29, December.
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