Determinants of Willingness to Use Oral HIV Pre-Exposure Prophylaxis Among Transgender Women in Colombia

Purpose: This study examined the willingness of transgender women (TGW) to use oral HIV pre-exposure prophylaxis (PrEP) to prevent HIV. Using the information-motivation-behavioral skills (IMB) model, the study considered both social (e.g., unstable housing) and psychosocial (e.g., depressive symptoms) influences on this willingness. Methods: We conducted a cross-sectional study of TGW from October 2020 to February 2021, collaborating with community-based organizations to administer face-to-face surveys. We used logistic regression to identify the determinants of willingness to use PrEP and test the mediating effect of PrEP self-efficacy on the relationship between information/motivation and the willingness to use PrEP, as well as the effects of social and psychosocial factors on the IMB model. Results: A total of 68% of participants, with an average age of 32, were willing to use PrEP within 12 months. Willingness was higher among those who were younger, had lower socioeconomic status, lacked stable housing, or held positive attitudes toward PrEP. Information factors were not related to willingness. Motivational factors such as positive social norms and high self-efficacy increased willingness, whereas depressive symptoms and PrEP-related stigma reduced it. Motivational factors mediated the relationship between depressive symptoms and willingness to use PrEP. Conclusions: The IMB model effectively explained the main determinants of willingness to use PrEP in the studied population. Interventions addressing motivations, reducing PrEP-related stigma, and managing depressive symptoms are crucial for TGW. Future research and interventions should focus on younger and more socially vulnerable TGW who are willing to use oral PrEP.