Willingness to use pre-exposure prophylaxis among Mexican transgender women: A latent class analysis

Background/ObjectivesTransgender women in Mexico face a high HIV prevalence, yet they remain insufficiently engaged in pre-exposure prophylaxis (PrEP). This study aimed to evaluate willingness to use HIV pre-exposure prophylaxis (PrEP) and its connection to risk behaviors among transgender women in Mexico.MethodsIn 2021, a cross-sectional study was conducted among Mexican transgender women to assess HIV risk factors and willingness to use PrEP. We used Latent Class Analysis to cluster participants with similar HIV risk behaviors, and multivariable logistic regression to identify covariates of willingness to use PrEP.ResultsAmong 266 transgender women, 40% were aware of PrEP, yet 78% reported willingness to use it after a brief introduction. Only 25% of the participants perceived themselves at high HIV risk. Through Latent Class Analysis, three classes were identified: 1) transactional sex with lower risk (10%); 2) no transactional sex with higher risk (25%); and 3) transactional sex with higher risk (65%), with reported willingness to use PrEP at 61%, 66% and 85%, respectively. In the multivariable model, belonging to class 3 (vs class 1) was associated with higher willingness to use PrEP (aOR:3.3; CI:1.2-9.5).ConclusionsWillingness to use PrEP aligned with HIV risk in those with a higher risk (class 3) and lower risk (class 1), but not in those at higher risk despite not reporting transactional sex (class 2). Therefore, not all who could benefit from PrEP may want it. Strategies are needed to promote PrEP's awareness and willingness to use considering the needs of transgender women subgroups.