{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:36Z","timestamp":1787022096397,"version":"build-2736575974"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T00:00:00Z","timestamp":1643241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["P30 AI027767-32"],"award-info":[{"award-number":["P30 AI027767-32"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["T32HS013852"],"award-info":[{"award-number":["T32HS013852"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>HIV prevalence is high among transgender women (TGW) in the Southeastern U.S. Uptake of HIV Pre-Exposure Prophylaxis (PrEP) is low among TGW nationwide. We aimed to explore beliefs associated with PrEP among TGW in the Southeastern U.S., framed by the Health Belief Model. HIV-negative TGW \u226518 years old in Alabama participated in virtual focus group discussions. Authors coded and amended transcripts to explore emerging themes. Between July-December 2020, 17 TGW participated in 4 sessions. Mean age was 28.1\u00b18.5 years. Several themes were identified: frustration with conflation of transgender identity and HIV risk, inappropriate transgender representation in PrEP advertising, concerns for interactions between PrEP and hormone therapy, perception that PrEP is meant for cisgender men who have sex with men and limited trans-affirming healthcare. Nuanced messaging is necessary to properly educate and engage TGW in HIV prevention strategies including PrEP given the diversity of this population.<\/jats:p>","DOI":"10.1371\/journal.pone.0262205","type":"journal-article","created":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T13:29:13Z","timestamp":1643290153000},"page":"e0262205","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["\u201cIt\u2019s behaviors, not identity\u201d: Attitudes and beliefs related to HIV risk and pre-exposure prophylaxis among transgender women in the Southeastern United States"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9362-6234","authenticated-orcid":true,"given":"Olivia T.","family":"Van Gerwen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika L.","family":"Austin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andres F.","family":"Camino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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Qualitative Data Analysis: A Methods Sourcebook. SAGE. 2014."},{"key":"pone.0262205.ref031","unstructured":"J C. Research design: Qualitative, quantitative, and mixed methods approaches 4th ed. Thousand Oaks, CA: SAGE; 2014."},{"issue":"1","key":"pone.0262205.ref032","doi-asserted-by":"crossref","DOI":"10.1177\/1609406917733847","article-title":"Thematic Analysis: Striving to Meet the Trustworthiness Criteria","volume":"16","author":"LS Nowell","year":"2017","journal-title":"International Journal of Qualitative Methods"},{"issue":"5","key":"pone.0262205.ref033","first-page":"1102","article-title":"Avoid Traps in member checking","volume":"15","author":"C. JA","year":"2010","journal-title":"Qual Rep"},{"key":"pone.0262205.ref034","unstructured":"QSR International Pty L. 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