Attitudes Toward and Preferences for Routes of Delivery of HIV Pre-exposure Prophylaxis Among Young Transgender Men and Transmasculine People.

Purpose: Because delivery route may impact interest in human immunodeficiency virus pre-exposure prophylaxis (PrEP), we explored the attitudes toward and preferences of young transgender men and transmasculine youth (TG men) for PrEP delivery methods that are currently available and in development.

Methods: Fifteen TG men aged 15-24 years were recruited from a Midwestern US youth-serving gender clinic. Participants completed theory-guided individual interviews assessing demographics, risk behaviors, attitudes toward and preferences for PrEP delivery routes, and experiences with hormones for vaginal bleeding management. Transcripts were analyzed using content analysis.

Results: Mean age was 17.7 years (standard deviation 1.4); 12 identified as White, two biracial, and 1 Black; and 13 were sexually experienced. Oral pill benefits included ease of use, no planning around sex; barriers included adherence challenges, difficulty swallowing pills. Injection benefits included long-acting, ease of adherence; barriers included delivery as injection, discomfort with gluteal injection. Vaginal ring benefits included ease of use, long-acting; barriers included discomfort with vaginal objects, exacerbation of gender dysphoria. Topical benefits included as-needed use, ease of use; barriers included dislike of formulation, discomfort using vaginal/rectal products. Implant benefits included long-acting, ease of use; barriers included placement procedure, concerns about breakage/migration. Four of five participants who had experience with injection, implant, or intrauterine device for bleeding management reported preference for a PrEP implant. Six of nine participants who had experience with contraceptive pills reported preference for a PrEP pill.

Discussion: PrEP uptake may be improved through clinicians' eliciting and addressing barriers to PrEP delivery routes identified by young TG men.