Scientists announced the results of the IPrex trial in November 2010, showing that overall, a daily dose of Truvada, a combination of two oral antiretroviral drugs, tenofovir disoproxil fumarate and emtricitabine, reduced HIV infection in a sample of high ‐ risk men who have sex with men (MSM) and transgender (TG) women by 44 percent. Among those study participants who took Truvada 90 percent of the time, the effect increased to a 73 percent reduction in new infections. While these findings are significant, and have implications for the HIV prevention arena, it is unclear how the trial results will be understood and implemented among medical providers serving MSM and TG communities and MSM and TG individuals who may seek out PrEP. This is a study to examine the acceptability of PrEP among medical providers and high risk MSM and TG women who may be candidates for this form of HIV prevention. We would interview providers to determine the optimum package of services necessary to implement PrEP to high risk patients, how implementation of PrEP would impact clinic capacity, and the kind of monitoring and counseling providers would give to patients on PrEP. Similarly, we would interview high ‐ risk MSM and TG women to learn about their willingness to take  Truvada daily, to better understand their perceptions of the risks and benefits of taking PrEP, and how daily adherence to PrEP, regular doctor visits and tests would fit into their day‐ to ‐ day lives.

Study aims:

• To better understand how providers approach managing patients who want to use PrEP as a prevention strategy.

• To explore the perspectives of high risk MSM and TG women regarding the potential use of PrEP as an ongoing HIV prevention strategy.

• To model the community level impact and cost ‐effectiveness of PrEP in reducing the number of new HIV infections in SanFrancisco