{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:57:05Z","timestamp":1787162225479,"version":"build-2736575974"},"reference-count":48,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Allergy and Infectious Diseases (NIAID)","award":["UG3\/UH3AI133669"],"award-info":[{"award-number":["UG3\/UH3AI133669"]}]},{"name":"National Institute of Allergy and Infectious Diseases (NIAID)","award":["UH3AI133669"],"award-info":[{"award-number":["UH3AI133669"]}]},{"name":"National Institute of Allergy and Infectious Diseases (NIAID)","award":["K01MH134764"],"award-info":[{"award-number":["K01MH134764"]}]},{"name":"Diversity Supplement for Dr. Rodrigo Aguayo-Romero","award":["UG3\/UH3AI133669"],"award-info":[{"award-number":["UG3\/UH3AI133669"]}]},{"name":"Diversity Supplement for Dr. Rodrigo Aguayo-Romero","award":["UH3AI133669"],"award-info":[{"award-number":["UH3AI133669"]}]},{"name":"Diversity Supplement for Dr. Rodrigo Aguayo-Romero","award":["K01MH134764"],"award-info":[{"award-number":["K01MH134764"]}]},{"name":"NIMH","award":["UG3\/UH3AI133669"],"award-info":[{"award-number":["UG3\/UH3AI133669"]}]},{"name":"NIMH","award":["UH3AI133669"],"award-info":[{"award-number":["UH3AI133669"]}]},{"name":"NIMH","award":["K01MH134764"],"award-info":[{"award-number":["K01MH134764"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>In the United States (U.S.), Latina transgender women (LTW) are highly burdened by HIV and are prioritized for pre-exposure prophylaxis (PrEP). This study explored intersectional barriers and facilitators to PrEP uptake among LTW. Between February\u2013November 2022, in-depth interviews were conducted with 27 LTW in the LITE Study. Participants were purposively sampled from 196 LTW in the cohort based on PrEP uptake (PrEP-na\u00efve n = 8, PrEP-eligible and not user n = 5, current PrEP user n = 6, previous PrEP user n = 8). We conducted content analysis guided by a Modified Social Ecological Model and Intersectionality Framework. The mean age of participants was 32.3 (SD = 12.9). Themes were: (1) Intrapersonal: Medical distrust, acceptability of PrEP modalities, and concerns about long-term health; (2) Interpersonal: Mistreatment in healthcare, discrimination-related healthcare avoidance, difficulty finding trans-competent providers, language barriers, and shame and stigma; and (3) Structural: PrEP in the context of limited access to gender-affirming care and widespread silicone use, immigration status, economic marginalization, lack of community outreach, transphobia and anti-transgender legislative contexts, and xenophobia. This study found multilevel intersectional barriers influence PrEP uptake and persistence. Culturally tailored HIV prevention efforts are needed to address LTW-specific barriers, provide information on programs subsidizing PrEP, and implement policy change to ensure equitable PrEP access.<\/jats:p>","DOI":"10.3390\/ijerph22050659","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T20:24:52Z","timestamp":1745353492000},"page":"659","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["\u201cWhen Somebody Comes into This Country and You Are Trans on Top of That Is Like You Got\u2026 Two Strikes on You\u201d: Intersectional Barriers to PrEP Use Among Latina Transgender Women in the Eastern and Southern United States"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1217-8466","authenticated-orcid":false,"given":"Rodrigo A.","family":"Aguayo-Romero","sequence":"first","affiliation":[{"name":"The Institute for Health Research & Policy at Whitman Walker, Washington, DC 20009, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genesis","family":"Valera","sequence":"additional","affiliation":[{"name":"The Fenway Institute, Fenway Health, Boston, MA 02215, USA"},{"name":"Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9563-1822","authenticated-orcid":false,"given":"Erin E.","family":"Cooney","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"},{"name":"Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2063-1534","authenticated-orcid":false,"given":"Andrea L.","family":"Wirtz","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"},{"name":"Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sari L.","family":"Reisner","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.2105\/AJPH.2018.304727","article-title":"Estimating the Prevalence of HIV and Sexual Behaviors Among the US Transgender Population: A Systematic Review and Meta-Analysis, 2006\u20132017","volume":"109","author":"Becasen","year":"2019","journal-title":"Am. 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