Facilitators and Barriers to Injectable PrEP Utilization for MSM and Transgender Women of Color in the US

Background: MSM and transgender women of color face distinct challenges in accessing and utilizing HIV pre-exposure prophylaxis (PrEP). In addition to racial and sexual identity stigmas, Black, Latino and Asian MSM may face higher degrees of PrEP stigma, which may at least partially be caused the perception that PrEP is only for promiscuous or irresponsible individuals. Given the reduced rates of oral PrEP uptake among communities of color, a new injectable version of PrEP may be a viable alternative. Emerging research has documented the safety and acceptability of long-acting injectable (LAI) PrEP or cabotegravir. However, the likelihood of MSM and transgender women of color utilizing LAI PrEP are largely unknown. In particular, Asian and Pacific Islander (API) MSM and transgender women of color are a significantly understudied population within the field of HIV prevention. Research has shown that API MSM are less knowledgeable about HIV services compared to Whites. Acculturation and cultural taboos against discussing private or sexual matters may influence Asians’ level of HIV knowledge and likelihood to access HIV prevention services.

Methods: This study involved the completion of 214, anonymous, web-based, surveys by sexually active MSM and transgender women of color to understand the facilitators and barriers to utilize LAI PrEP. Eligibility criteria included: (1) assigned male sex at birth, (2) had sex with a man in the past year; (3) resides in the United States; (4) over the age of 18, and (5) self-reported HIV-negative. The survey introduced a hypothetical PrEP study, assessing participants’ attitudes towards both oral and injectable PrEP usage. The survey took approximately 20 minutes to complete online. Utilizing the survey findings, we created a multiple linear regression model, predicting likelihood of utilizing LAI PrEP while controlling for race and age.

Results: Participants identified as cisgender men (65.42%); transgender women (20.56%); and gender-nonconforming (14.02%). Participants mostly identified as gay (43.93%) or bisexual (36.92%), and had an average of 6.94 male partners (SD = 23.54) over the past year. The sample included 70 Asian participants, 77 Blacks/African Americans, 70 Hispanics/Latinos, and 6 American Indians/Alaska Natives. The most common perceived benefit to LAI use was HIV protection (57.01%) and the most common perceived risk was side effects (59.81%). The majority of participants (53.4%) reported that they were either somewhat or extremely likely to come to a clinic every two months to get an LAI PrEP injection. Asian participants were less likely to utilize LAI PrEP (unstandardized b = -0.707, p=0.012) as were participants living at home with their families (unstandardized b = -0.688, p = 0.039). However, participants who had previously taken oral PrEP were more likely to utilize LAI PrEP (unstandardized b = 0.893, p = 0.005).

Conclusion & Implications: These findings have important implications for social workers working in the arena of health disparities, in better designing HIV prevention research studies and interventions that target marginalized communities. Better understanding the contexts that make access to HIV prevention challenging for Asian American queer populations can improve healthcare and social service delivery.