The dangerous intersection of violence and HIV infection

A Gap Between Willingness and Uptake: Findings From Mixed Methods Research on HIV Prevention Among Black and Latina Transgender Women

BACKGROUND

Black and Latina transgender women (BLTW) face significant HIV disparities with estimated HIV prevalence up to 50% and annual incidence rates as high as 2.8 per 100 person-years. However, few studies have evaluated the acceptability and uptake of high-impact HIV prevention interventions among BLTW.

SETTING

Data collection took place in Baltimore, MD and Washington, DC from May 2015 to May 2017.

METHODS

This mixed methods study included quantitative interviewer-administered surveys, key informant interviews, and focus group discussions. Rapid HIV testing followed each survey. Logistic regression models tested associations between legal gender affirmation (ie, desired name and gender marker on identity documents), transgender pride, history of exchange sex, HIV risk perception, and willingness to take pre-exposure prophylaxis (PrEP). Transcripts of qualitative data were coded to identify common themes related to engagement in HIV prevention.

RESULTS

Among 201 BLTW, 56% tested HIV-positive and 87% had heard of PrEP. Only 18% who had heard of PrEP had ever taken it. Of the 72 self-reported HIV-negative or status-unknown BLTW who had never taken PrEP, 75% were willing to take it. In multivariable analyses, history of exchange sex was associated with willingness to take PrEP, whereas greater HIV knowledge and transgender pride were associated with lower likelihood of willingness to take PrEP. Concern about drug interactions with hormone therapy was the most frequently reported barrier to PrEP uptake.

CONCLUSIONS

Noting the disconnect between PrEP willingness and uptake among BLTW, HIV prevention programs could bridge this gap by responding to identified access barriers and incorporating community-derived strategies.

'It's not good to eat a candy in a wrapper': male students' perspectives on condom use and concurrent sexual partnerships in the eastern Democratic Republic of Congo

This paper reports on fieldwork carried out in 2011 with aim to investigate young men's perspectives about condoms use, concurrent sexual partnerships and sex in the context of HIV/AIDS. This study employed a qualitative approach to collect data from 28 boys aged 16-20 from two urban and two rural high schools in South Kivu province. Four focus group discussions and 20 individual interviews were conducted among them. The findings showed that most students identified condoms as unsafe and untrustworthy. Reasons given for the mistrust of condoms were related to the belief that condoms do not give enough protection from Sexually Transmitted Infections, HIV and pregnancies. Most participants believe that condoms have a 'small hole' or are unreliable and are therefore not effective in prevention. They also mentioned that condoms encourage inappropriate sexual activity. They prefer flesh-to-flesh sex rather than protected sex using a condom. However, a few participants acknowledged the importance of condom use. Despite the risk of HIV transmission, boys believe that it is appropriate for them to have concurrent sexual partnerships. They justified the concurrent sexual partnerships as a way of ensuring that they cannot miss a girl to satisfy their sexual desire. Given the boys' failure to use condoms and their strong inclination to concurrent sexual partnerships, there is a need for heath groups and stakeholders within the area to increase awareness about condoms' effectiveness and improve knowledge dissemination on Sexually Transmitted Diseases and how they are prevented.

Changing attitudes and beliefs towards a woman's right to protect against HIV risk in Malawi

Female empowerment and positive attitudes towards women's rights in sexual relationships have been found to be key elements of successful behaviour-based HIV prevention programmes. However, HIV prevention programmes that do not specifically engage with gender issues may also affect attitudes and beliefs towards women's rights within sexual relationships. Using data from the Malawi Longitudinal Study of Families and Health we compare measures of female empowerment and changing gender norms between intervention participants and non-participants. Results suggest that female intervention participants were more likely than non-participants to believe that: (1) women have more rights within sexual relationships in general and (2) women have the right to protect themselves against HIV risk (indicating possible increases in female self-efficacy in making HIV prevention decisions). Male intervention participants showed no substantial positive change in attitudes towards women's rights. These results highlight an important positive effect of HIV prevention programmes on women's attitudes towards their own rights.