ArticleAIDS and behavior2026
The Role of Healthcare-Related Experiences in Willingness and Preference for Long-Acting Injectable PrEP (LAI-PrEP) Among Transfeminine People in the United States.
Article in AIDS and behavior, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Transgender women and transfeminine people (TWTFP) experience disproportionately high HIV prevalence, low HIV pre-exposure prophylaxis (PrEP) coverage, and negative healthcare experiences. Long-acting injectable PrEP (LAI-PrEP) and daily oral-PrEP are delivered under different healthcare interaction protocols. We examined the role of healthcare-related experiences on willingness and preference for LAI-PrEP among a U.S. nationwide sample of sexually active TWTFP aged 15+. Recruitment occurred between 6/2022 and 10/2023 via social media advertisements for a cross-sectional online sexual health survey. Analyses included past-year PrEP naïve TWTFP with no prior HIV diagnosis (N = 1648). Participants reported LAI-PrEP willingness and ranked PrEP modality preferences; recent healthcare-related experiences were explored as correlates, using adjusted multivariable Poisson regression with robust variance estimation. Among respondents, 26.3% were willing to use LAI-PrEP (n = 433/1648). Among participants willing to use LAI-PrEP and another modality (n = 390/433; 90.1%), 45.6% (n = 178/390) preferred LAI-PrEP. Discussing sexual health with a healthcare provider (HCP) was associated with increased LAI-PrEP willingness (adjusted prevalence ratio [aPR] = 1.34; 95% confidence interval [CI] = 1.12-1.60; p = 0.001); use of oral prescription medication (non-hormonal) was associated with decreased LAI-PrEP willingness (aPR = 0.60; 95% CI = 0.38-0.93; p = 0.022). No significant associations were found between healthcare-related experiences and LAI-PrEP preference. Given that most TWTFP who were willing to use LAI-PrEP were also willing to use oral-PrEP, but nearly half preferred LAI-PrEP, offering multiple PrEP modalities is essential to meet their needs. Associations between sexual health discussions and increased LAI-PrEP willingness highlight the importance of HCP engagement; initiatives which encourage HCPs to initiate LAI-PrEP conversations in supportive ways are crucial. Associations between oral prescription use and decreased LAI-PrEP willingness, coupled with null findings related to injection use, highlight the need for further investigation.
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