{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T07:51:07Z","timestamp":1791445867387,"version":"4.3.3"},"reference-count":77,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Transgender women in Asia face a high HIV burden, yet remain underrepresented in pre\u2010exposure prophylaxis (PrEP) research. Despite increases in PrEP availability, uptake among trans women remains low. This study examines PrEP awareness, use, and\u00a0willingness among trans women across 11 Asian countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2010country cross\u2010sectional 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1178 trans women participants, 80.0% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0942) had heard of PrEP. Among those who were PrEP\u2010aware, 62.6% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0590\/942) reported ever using it, and of these, 78.1% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0461\/590) were current users. Among PrEP\u2010na\u00efve participants classified as at risk of HIV (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0265), 60.0% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0159\/265) were willing to initiate PrEP, yet only 34.0% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a054\/159) were also willing to pay. Lifetime PrEP use was positively associated with wider country\u2010level PrEP access (aOR\u00a0=\u00a04.34; 95% CI: 3.03\u20136.21), genital surgery (aOR\u00a0=\u00a01.54; 1.03\u20132.31), current romantic relationship (aOR\u00a0=\u00a01.65; 1.19\u20132.29), as well as reporting sex work (aOR\u00a0=\u00a01.51; 1.05\u20132.18), condomless sex (aOR\u00a0=\u00a01.76; 1.28\u20132.42), chemsex (aOR\u00a0=\u00a01.98; 1.36\u20132.87), and a recent sexually transmitted infection diagnosis (aOR\u00a0=\u00a02.28; 1.45\u20133.59) within the past 6 months. Negative associations included older age (aOR per year\u00a0=\u00a00.94; 0.92\u20130.96) and discrimination from healthcare workers (aOR\u00a0=\u00a00.66; 0.47\u20130.93). Willingness to use PrEP was lower among older participants (aOR per year\u00a0=\u00a00.97; 0.94\u20130.99) and those in countries with wider PrEP access (aOR\u00a0=\u00a00.53; 0.29\u20130.97), with no significant associations observed for behavioural risks.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PrEP awareness was high among trans women in Asia. PrEP use and willingness were influenced by structural barriers (e.g. country\u2010level PrEP access), healthcare discrimination, and personal factors (e.g. behavioural risks). Scaling up PrEP for trans women requires rights\u2010based approaches and commitment to achieve equitable HIV prevention in the region.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70209","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:57:37Z","timestamp":1791442657000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["PrEP Use and Willingness Cascades Among Transgender Women in 11 Asian Countries: Findings From the PrEP APPEAL Cross\u2010Sectional Online Survey"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9498-6207","authenticated-orcid":false,"given":"Alegra","family":"Wolter","sequence":"first","affiliation":[{"name":"Kirby Institute University of New South Wales (UNSW) Sydney  Sydney New South Wales Australia"},{"name":"School of Population Health UNSW Sydney  Sydney New South Wales 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