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PrEP Use and Willingness Cascades Among Transgender Women in 11 Asian Countries: Findings From the PrEP APPEAL Cross‐Sectional Online Survey

Year: 2026

Type: article

Abstract: INTRODUCTION: Transgender women in Asia face a high HIV burden, yet remain underrepresented in pre-exposure prophylaxis (PrEP) research. Despite increases in PrEP availability, uptake among trans women remains low. This study examines PrEP awareness, use, and willingness among trans women across 11 Asian countries. METHODS: Data were drawn from the 2022 PrEP Product Awareness, Preferences, and Past Experiences Among Transgender Women and Men Who Have Sex with Men (PrEP APPEAL) study, a multi-country cross-sectional online survey. Two PrEP cascades were constructed: one assessing use (awareness, lifetime use, current use) and the other assessing willingness (risk, interest, and willingness to pay). Logistic regression models were used to identify factors associated with lifetime PrEP use and willingness to use PrEP. RESULTS: Of 1178 trans women participants, 80.0% (n = 942) had heard of PrEP. Among those who were PrEP-aware, 62.6% (n = 590/942) reported ever using it, and of these, 78.1% (n = 461/590) were current users. Among PrEP-naïve participants classified as at risk of HIV (n = 265), 60.0% (n = 159/265) were willing to initiate PrEP, yet only 34.0% (n = 54/159) were also willing to pay. Lifetime PrEP use was positively associated with wider country-level PrEP access (aOR = 4.34; 95% CI: 3.03-6.21), genital surgery (aOR = 1.54; 1.03-2.31), current romantic relationship (aOR = 1.65; 1.19-2.29), as well as reporting sex work (aOR = 1.51; 1.05-2.18), condomless sex (aOR = 1.76; 1.28-2.42), chemsex (aOR = 1.98; 1.36-2.87), and a recent sexually transmitted infection diagnosis (aOR = 2.28; 1.45-3.59) within the past 6 months. Negative associations included older age (aOR per year = 0.94; 0.92-0.96) and discrimination from healthcare workers (aOR = 0.66; 0.47-0.93). Willingness to use PrEP was lower among older participants (aOR per year = 0.97; 0.94-0.99) and those in countries with wider PrEP access (aOR = 0.53; 0.29-0.97), with no significant associations observed for behavioural risks. CONCLUSIONS: PrEP awareness was high among trans women in Asia. PrEP use and willingness were influenced by structural barriers (e.g. country-level PrEP access), healthcare discrimination, and personal factors (e.g. behavioural risks). Scaling up PrEP for trans women requires rights-based approaches and commitment to achieve equitable HIV prevention in the region.

Source: Journal of the International AIDS Society

DOI: 10.1002/jia2.70209