Understanding the Acceptability of Broadly Neutralizing Antibodies for HIV Prevention Among At-Risk Populations and Feasibility Considerations for Product Introduction in India: Protocol for a Qualitative Study (Preprint)

List of Figures. List of Tables. Figure Sources. Preface. Part I: Describing and Explaining Health in Geographical Settings:. 1. Introducing Geographies of Health. Health and Geography: Some Fundamental Concepts. Concepts of health. Geographical concepts. Geographies of Health: Five Case Studies. Asthma in New York. Area effects on smoking in disadvantaged communities in Glasgow. The changing political economy of sex in South Africa. The personal significance of home. Embodied spaces of health and medical information on the Internet. Concluding Remarks. Further Reading. 2. Explaining Geographies of Health. Positivist Approaches to the Geography of Health. Positivist explanation. Further examples of positivist approaches. Social Interactionist Approaches to the Geography of Health. Social interactionist explanation. Further examples of social interactionist approaches. Structuralist Approaches to the Geography of Health. Structuralist explanation. Further examples of structuralist or conflict-based approaches. Structurationist Approaches to the Geography of Health. Structurationist explanation. Further examples of structurationist approaches. Post-structuralist Approaches to the Geography of Health. Post-structuralist explanation. Further examples of post-structuralist approaches. Concluding Remarks. Further Reading. 3. Method and Technique in the Geography of Health. Mapping the Geography of Health: Quantitative Approaches. Visualization. Exploratory spatial data analysis. Modeling health data in a spatial setting. Geographical information systems and health. Interpreting the Geography of Health: Qualitative Approaches. Interviews. Focus groups. Other qualitative methods. Qualitative data analysis. Rigor in qualitative research. Concluding Remarks. Further Reading. Part II: Health and the Social Environment:. 4. Inequalities in Health Outcomes. Patterns of Inequality. Health inequalities: international comparisons. One Europe or many?. Health inequalities: regional and class divides. Explaining Inequalities in Health Outcomes. The programming hypothesis and the life course. Behavioral (lifestyle) factors. Social and community influences. Working conditions and local environments. Material deprivation and health. Concluding Remarks. Further Reading. 5. Inequalities in the Provision and Utilization of Health Services. Principles of Health Service Delivery. Levels of health care provision. Geographies of rationing. Efficiency and equity. The need for health care. Inequalities in the Provision of Health Services. Health care provision in developing countries. Health care provision in the developed world. Utilization of Services. Use of primary health care services. Use of secondary and tertiary health care services. Do Provision and Utilization Affect Outcome?. Concluding Remarks. Further Reading. 6. People on the Move: Migration and Health. Impact of Migration on Health. Migration and stress. The health of refugees. The impact of migration on the spread of disease. Migration and the incidence of disease and ill-health. Impact of Health Status on Migration. The selectivity of migration. Migration for health care and social support. The Relationship between Migration and the Delivery of Health Services. Concluding Remarks. Further Reading. Part III: Health and Human Modification of the Environment:. 7. Air Quality and Health. Types of Pollutants. Area Sources. Radon. Ozone. Linear Sources. Point Sources. Point sources in the developing world. Point sources in the developed world. Concluding Remarks. Further Reading. 8. Water Quality and Health. Water-borne Diseases. Cholera. Schistosomiasis. Gastroenteritis. Water Hardness. Chemical Contamination of Drinking Water. Aluminium, fluoride and arsenic. Other Forms of Contamination. Hazardous waste sites. Concluding Remarks. Further Reading. 9. Health Impacts of Global Environmental Change. Stratospheric Ozone Depletion. Ozone depletion and skin cancer. Other health impacts of ozone depletion. Global Climate Change. Direct effects: thermal stress. Indirect effects. Impacts on infectious (especially insect-borne) disease. Other health effects of climate change. Health Effects of Other Global Environmental Change. Concluding Remarks. Further Reading. 10. Conclusions: Emerging Themes in Geographies of Health. The Macro-scale: Health and the Global. The Meso-scale. The Micro-scale. References. Appendix: Web-based Resources for the Geographies of Health. Index

Health service managers and policy makers are increasingly concerned about the sustainability of innovations implemented in health care settings. The increasing demand on health services requires that innovations are both effective and sustainable; however, research in this field is limited, with multiple disciplines, approaches and paradigms influencing the field. These variations prevent a cohesive approach, and therefore the accumulation of research findings, in the development of a body of knowledge. The purpose of this paper is to provide a thorough examination of the research findings and provide an appropriate theoretical framework to examine sustainability of health service innovation. This paper presents an integrative review of the literature available in relation to sustainability of health service innovation and provides the development of a theoretical framework based on integration and synthesis of the literature. A theoretical framework serves to guide research, determine variables, influence data analysis and is central to the quest for ongoing knowledge development. This research outlines the sustainability of innovation framework; a theoretical framework suitable for examining the sustainability of health service innovation. If left unaddressed, health services research will continue in an ad hoc manner, preventing full utilisation of outcomes, recommendations and knowledge for effective provision of health services. The sustainability of innovation theoretical framework provides an operational basis upon which reliable future research can be conducted.

Background: Though substantial progress has helped curb the HIV epidemic, high rates of new HIV infections persist among adolescent girls and young women (AGYW) in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and sexual and reproductive health (SRH) services. The scale-up of oral pre-exposure prophylaxis (PrEP) and multiple novel HIV prevention products on the horizon offer countries a unique opportunity to expand innovative approaches to deliver comprehensive, integrated HIV prevention/SRH services.Methods: This article comparatively analyzes findings from rapid assessments in Kenya, Malawi and Zimbabwe across key themes to highlight cross-country trends and contextual realities around HIV prevention/SRH integration, with a focus on oral PrEP and contraception. In Kenya and Zimbabwe, assessments were completed by Ministries of Health (MOH) and the HIV Prevention Market Manager and include 20 health facility assessments, 73 key informant interviews (KIIs) and six community dialogues. In Malawi, the assessment was completed by the MOH and Georgetown University Center for Innovation in Global Health and includes 70 KIIs and a review of national policies and program implementation in Blantyre. Findings were contextualized through a review of literature and policies in each country.Results: Across countries, the policy environment is conducive to HIV prevention/SRH integration, though operationalization presents ongoing challenges, with most policies preceding and not accounting for oral PrEP rollout. National coordination mechanisms, youth-friendly health services and prevention of mother-to-child transmission programs are promising practices, while siloed and resource-constrained health systems, limited provider capacity, underfunded demand generation and structural factors exacerbate barriers to achieving integration.Conclusions: As new HIV prevention products are introduced, demand for integrated HIV prevention/SRH services is likely to grow. Investing in HIV prevention/SRH integration can help to ensure a sustainable response to the HIV epidemic, streamline service delivery and improve the health outcomes and lives of AGYW.

BackgroundTransgender women have multiple disparities globally, including social rejection and stigma, HIV infection and untreated mental health problems. However, few data on transgender women are available in China. Therefore, this study aimed to explore transgender women’s experiences on gender identity, disclosure, discrimination, transgender-specific medical care, and perceptions of HIV and sexually transmitted infections (STI) risk in China.MethodsA qualitative study was conducted in Nanjing and Suzhou city, China in 2018. Key informant interviews (n = 14) and focus group discussions (n = 2) with diverse transgender women were implemented. Text was transcribed and translated, and Dedoose™ software was used for coding, analysis and interpretation by the research team.ResultsChinese transgender women share experiences with transgender women worldwide, including a long and challenging identity search, stigma and discrimination, poor access to trans-specific services and unmet needs for mental health care. Features unique to them include terms used for self-identification, culturally-shaped expectations for reproduction, and ideals of placing the familial and societal welfare over personal fulfillment. Social networks of this population appear sparse, scattered, and underground. Familial rejection was experienced by nearly all respondents. Perceptions of HIV and STI risk and history of HIV testing were notably low.ConclusionsTransgender women in China face high social rejection and discrimination along with unmet need for various types of healthcare. Scaling up transgender-specific services including gender-affirming medical care, mental health care and HIV/STI prevention are warranted to address the social, medical and mental health of transgender women in China.

BackgroundMicroarray patches (MAPs), a novel drug delivery system, are being developed for HIV pre-exposure prophylaxis (PrEP) delivery and as a multipurpose prevention technology (MPT) to protect from both HIV and unintended pregnancy. Prevention technologies must meet the needs of target audiences, be acceptable, easy to use, and fit health system requirements.MethodologyWe explored perceptions about MAP technology and assessed usability, hypothetical acceptability, and potential programmatic fit of MAP prototypes using focus group discussions (FGD), usability exercises, and key informant interviews (KII) among key populations in Kiambu County, Kenya. Adolescent girls and young women (AGYW), female sex workers (FSW), and men who have sex with men (MSM) assessed the usability and acceptability of a MAP prototype. Male partners of AGYW/FSW assessed MAP acceptability as partners of likely users. We analyzed data using NVivo, applying an inductive approach. Health service providers and policymakers assessed programmatic fit. Usability exercise participants applied a no-drug, no-microneedle MAP prototype and assessed MAP features.ResultsWe implemented 10 FGD (4 AGYW; 2 FSW; 2 MSM; 2 male partners); 47 mock use exercises (19 AGYW; 9 FSW; 8 MSM; 11 HSP); and 6 policymaker KII. Participants reported high interest in MAPs due to discreet and easy use, long-term protection, and potential for self-administration. MAP size and duration of protection were key characteristics influencing acceptability. Most AGYW preferred the MPT MAP over an HIV PrEP-only MAP. FSW saw value in both MAP indications and voiced need for MPTs that protect from other infections. Preferred duration of protection was 1–3 months. Some participants would accept a larger MAP if it provided longer protection. Participants suggested revisions to the feedback indicator to improve confidence. Policymakers described the MPT MAP as “killing two birds with one stone,” in addressing AGYW needs for both HIV protection and contraception. An MPT MAP is aligned with Kenya's policy of integrating health care programs.ConclusionsMAPs for HIV PrEP and as an MPT both were acceptable across participant groups. Some groups valued an MPT MAP over an HIV PrEP MAP. Prototype refinements will improve usability and confidence.

PurposeTelemedicine are experiencing an unprecedented boom globally since the beginning of the COVID-19 pandemic. As the most vulnerable groups amid COVID-19, the digital delivery of healthcare poses great challenges to the elderly population, caregiver, health service providers, and health policy makers. To bridge the service delivery gaps between the telemedicine demand side and supply side, explore evidence-based approach for integrated care, address challenges for aging policy, and build foundation for the development of data-driven and community-based telemedicine, our R&D team applied translational research to design and develop telemedicine “SMART” for enhancing elderly mental health wellbeing amid COVID-19. Our aim is to investigate the preparedness mechanisms of mental health disease including response, intervention, and connection these three healthcare delivery pipelines with the collection, consolidation, and synergy of heath parameters and social determinants, using data analytics approach to achieve Evidence-Based Medicine (EBM).MethodsA mix of quantitative and qualitative research design for scientifically rigorous consultation and analysis was conducted from Jan 2020 to June 2021 in Hong Kong. An exploratory and descriptive qualitative design was used in this study. The data were collected through focus group discussions conducted from elderly and their caregivers living in 10 main districts of Hong Kong. Our research pilot tested “SMART” targeting for elderly with mental health improvement needs. Baseline questionnaire with 110 tele-medicine product users includes questions on demographic information, self-rated mental health digital adoption. The follow-up five focus group discussions with 57 users (elderly and their caregivers) further explore the social determinants of telemedicine transformation and help propose the integrated telemedicine paradigm shift framework establishment, development, and enhancement.ResultsGrounded on the baseline needs assessment and feedbacks collected, it is evident that multi-dimensional health information from the four various streams (community, clinic, home, remote) and customized digital health solutions are playing a key role in addressing elderly mental health digital service needs and bridging digital divide. The designed tele-medicine product lines up health service provider (supplier side) and elderly specific needs (demand side) with our three-level design, enables elderly and their families to follow and control their own health management and connect with the service provider, community of practice (CoP), and health policy makers.ConclusionIt’s beneficial to involve elderly and gerontechnology stakeholders as part of Community-Based Participatory Research (CBPR) before and throughout the developing and delivery phases an integrated and age-friendly digital intervention. The challenges in applying and disseminating telemedicine reflected by the elderly and caregivers can be used as important input for further development and indicators for the sustainable and integrated elderly primary care framework.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13755-022-00198-4.

Transgender women [TGW] in Colombia are disproportionately affected by HIV due to their low sociodemographic conditions, varied risk behaviours, difficulty accessing health services, and discrimination. Offering pre-exposure prophylaxis [PrEP] as part of a combination of prevention strategies is an appropriate option for this population to reduce their risk of HIV infection. However, little is known about how to implement a PrEP program for TGW in Colombia. Between June and October 2020, we conducted individual interviews with 16 TGW from four different cities in Colombia. The interviews assessed contextual influences, knowledge, skills, perceptions, and beliefs. We used qualitative thematic analysis to identify themes and the Capability, Opportunity, Motivation, and Behavior framework to further delineate barriers and possible interventions. After delineating the main themes across the three subdomains of the model, nine barriers were identified: one related to capability, knowledge, and perception of PrEP; six related to opportunity, which includes, family relations, sexual work environment, stable partner relations, interactions with healthcare workers, health service provision, and community interactions and opportunities; and two related to motivation, mental health, and concerns about medication side effects. Mapping barriers with interventions generated the following intervention functions: education, training, enablement, and environmental structure; and the following policy functions: communication/marketing, legislation, and changes in service provision. Examples of possible interventions are presented and discussed.

The nursing role in primary care is increasing in importance, particularly in the Australian health care system (Royal College of Nursing Australia [RCNA] 2003). The expanding nursing role in primary care has implications for the health of Australian society, nursing education, continuing professional development, health service policy, inter-professional politics, regulatory affairs and the monitoring of standards and professional practice. Professional nursing organisations represent the voice of their membership in influencing development of public policy, setting professional standards and in promoting the profession and raising awareness of its vital role and contribution to the health care sector (Australian Practice Nurses Association 2007; RCNA 2007).A range of variables has contributed to shaping the nursing role in the general practice setting. Perhaps the most significant of these to date include legal and industrial factors and consumer expectations. However, the political challenges of introducing change and innovation in nursing in general practice must also be given careful consideration. Professional leadership that successfully manages the complex interplay of these and other factors will be important in advancing the role in the future.As this nursing role evolves it is important that the nursing profession, including professional, industrial and regulatory representatives work collaboratively to promote the health and well-being of Australians. The impact of this role on health service provision also needs to be carefully examined through research processes in order to build an evidence-base. Evaluative data will be useful in developing and expanding the role in the future in defensible ways through policy development.In this special issue of Contemporary Nurse, McMurray (2007) emphasises the importance of leadership in primary care and provides us with useful strategies for promoting the health of communities. Hall et al. (2007) and Porritt (2007) trace the recent developments of the practice nurse role in Australian general practice and underscore the importance of policy in driving health care reforms and developing nurses' roles that are responsive to needs of contemporary health care systems.Models of nursing roles in primary care should complement and support the role of other health practitioners, particularly the general practitioner. The role for the nurse practitioner in general practice will evolve as multidisciplinary models of care are advanced, in order to enhance existing service provision and improve access to primary care for all consumers. Nursing is in a good position to influence development of these models, the end point of which must be improved health outcomes for consumers of these services. Consequently education initiatives in the undergraduate, post graduate and professional development sphere need to prepare nurses to work collaboratively with multidisciplinary colleagues, particularly in the general practice setting. Nurses working in specialist domains of practice should also establish links with nurse colleagues in the primary care setting to support their professional growth, promote the quality and continuity of clinical care and in developing practice-based research and scholarship.Over the last five years, nursing in Australian general practice has developed substantially and will evolve as multidisciplinary models of care are advanced to improve existing service provision and improve access to primary care for all consumers (Council of Deans of Nursing and Midwifery of Australia and New Zealand 2004). …

BackgroundCervical cancer is the primary cause of cancer death for women in Nicaragua, despite being highly preventable through vaccination against high-risk genotypes of the Human Papillomavirus (hrHPV), screening for hrHPV, and early detection of lesions. Despite technological advances designed to increase access to screening in low resource settings, barriers to increasing population-level screening coverage persist. On the Caribbean Coast of Nicaragua, only 59% of women have received one lifetime screen, compared to 78.6% of eligible women living on the Pacific and in the Interior. In concordance with the WHO’s call for best practices to eliminate cervical cancer, we explored the feasibility and acceptability of self-collection of samples for hrHPV testing on the Caribbean Coast of Nicaragua through a multi-year, bi-national, community-based mixed methods study.MethodsBetween 2016 and 2019, focus groups (n=25), key informant interviews (n=12) [phase I] and an environmental scan [phase II] were conducted on the Caribbean Coast of Nicaragua in partnership and collaboration with long-term research partners at the University of Virginia and community-based organizations. In spring 2020, underscreened women on the Caribbean Coast of Nicaragua were recruited and screened for hrHPV, with the choice of clinician collection or self-collection of samples.ResultsOver the course of the study, providers and potential patients expressed significant acceptability of self-collection of samples as a strategy to reduce barriers currently contributing to the low rates of screening (phases I and II). Ultimately 99.16% (n=1,767) of women chose to self-collect samples, demonstrating a high level of acceptability of self-collection in this pilot sample (phase III). Similarly, focus groups, key informant interviews, and the environmental scan (phases I and II) of resources indicated critical considerations for feasibility of implementation of both HPV primary screening and subsequently, self-collection of samples. Through phase III, we piloted hrHPV screening (n=1,782), with a 19.25% hrHPV positivity rate.ConclusionSelf-collection of samples for hrHPV testing demonstrated high acceptability and feasibility. Through concerted effort at the local, regional, and national levels, this project supported capacity building in reporting, monitoring, and surveilling cervical cancer screening across the continuum of cervical cancer control.

In this inaugural issue of the revived journal, Public Health Reviews, we seek to address a wide audience from the myriad disciplines that comprise the workforce of public health. In this effort, we hope to reach public health educators, researchers, students, policy makers, and practitioners worldwide with evidence-based theoretical and experiential knowledge. Applied nationally and internationally, public health has enormous global potential to save lives and improve quality of life if applied equitably throughout the world. The inaugural issue is therefore devoted to the New Public Health, as the basis for improving population health globally.The central idea behind this issue is to focus on some of the major challenges and possibilities for improving health in the coming decades. The New Public Health involves the interdependence of traditional local, state or provincial, national, and global public health initiatives and their societal and political contexts. European societies, as others, face the challenges of ageing populations, increasing costs and rising public and individual expectations. At the same time, there are many social, regional, and transnational disparities.1,2The New Public Health addresses traditional aspects of public health, as well as the great potential for prevention-oriented healthcare systems. The New Public Health seeks to safeguard and improve individual health in the context of social and economic disparities that exist in varying degrees in all countries and regions. Furthering the New Public Health implies crossfertilization between public health protection, health promotion, disease prevention, health maintenance, and environmental health in the context of improvement of societal, economic, industrial and community habitation policies. Management of health systems and resource allocation are crucial to setting priorities in prevention, and the effective organization and provision of health services are a cornerstone of society's responsibility for the health and well-being of the population.The New Public Health is not a new vision of what health should be; it is a strategic and equitable application of current best practices across the broadest aspects of social policy, public health, and healthcare systems. Ultimately, the New Public Health relies on the adoption of effective policies and programs based on the cumulative experience and available scientific evidence. Such programs and policies must be targeted to individuals, to groups at special risk, to communities, and to societies across the globe.In this issue, we seek to present the interdependence of social and health policy with examples illustrating the interconnectedness of healthcare systems issues. The topics included are not encyclopedic of all the vital issues facing public health systems in the 21st century. Many of those that are not included in this first issue will be addressed in later issues of the journal. Accordingly, we start with the application of science to public health practice, as in the case of Helicobacter pylori, and we move on through health systems, organization of public health, chronic diseases, micronutrient deficiencies and infectious diseases.In this issue, we include:Preface,3 and Foreword: Reminiscences of Helicobacter pylori.4 Respectively by Theodore Tulchinsky, Antoine Flahault, and Robin Warren (Nobel Prize 2005, Western Australia), who relates his experience of scientific discovery that was ultimately embraced by medical and public health practitioners and policy makers. This fascinating historical account provides a vivid example of translating science into practice with major impacts on population health and health services.Editorial: Why a journal called Public Health Reviews?5 Antoine Flahault and Linda Fried present the renewal of this journal with a wider international scope, reaching out to a European and worldwide readership.What is the "New Public Health"? …

The World Health Organization declared COVID-19 as a pandemic in March 2020. COVID-19 has since caused a significant increase in mental health problems at national and global levels. This study assessed the views of key mental health stakeholders regarding the state of mental health service provision in Malawi and the pandemic's impact on the sector. The study utilised a qualitative approach through key informant interviews (KIIs) conducted using a semi-structured interview guide. The interviews were audio recorded in English language and were manually transcribed for thematic analysis by generating codes re-classified into themes, sub-themes and quotes. The results are categorised into five themes. Firstly, the availability of mental health services. All experts confirmed the lack of availability of the mental health services especially at the lower levels of care. Currently, only 0.3% of facilities offer mental health services in Malawi. Moreover, although mental health services are part of the essential health care package and, therefore, are supposed to be provided for free in public facilities at all levels, the services are centralised and only functional at a tertiary level of care in public facilities. Secondly, funding sources for mental health in public and private facilities. We learnt that public facilities depend on donor sources and there is lack of prioritisation in budget allocation for mental health services. Whereas private facilities, their major source of funding is user fees. Thirdly, government's response in the provision of mental health services during COVID-19. Almost all experts echoed that government took a proactive approach to address the mental health needs of its population during the pandemic. There was increased collaboration between the government and the private sector to provide psychosocial and counselling services to health workers working directly with COVID-19 patients in isolation centres. Furthermore, to increase awareness of the general population on where to seek counselling services. Lastly, challenges in the provision of mental health services were highlighted and how the pandemic acerbated the challenges including shortage in human resources for health and inadequate funding. This study underscores the urgency of addressing mental health challenges in Malawi. Policymakers must prioritize the decentralization of mental health services, explore funding opportunities, and build on the successful collaboration with the private sector. These measures will not only enhance the accessibility and quality of mental health services but also ensure that mental well-being is a central component of public health efforts in Malawi.

Sleep disorders and risk of hospitalization in patients with mood disorders: Analysis of the National Sample Cohort over 10 years.

Over the last decade, many countries have adopted policies addressing menstrual needs. Our research explores the opportunities and challenges that have shaped these initiatives and critically examines their scope and substantive focus. Our study analyses developments in four countries: India, Kenya, Senegal, and the United States. It is based on an analysis of 34 policy documents and interviews with 85 participants active in policy-making or advocacy. Across countries, we found a predominant policy focus on tangible and material outcomes, such as menstrual products and facilities, that is informed by a narrow perception of menstrual needs as the management of bleeding. A number of drivers influenced policy-makers to keep this focus, especially the key narrative around menstrual pads as a perceived solution to school absenteeism combined with sensationalisation in the media and the quest for quantifiable results. Menstrual stigma is so ingrained that it continues to constrain policy-makers and advocates themselves by perceiving and presenting menstruation as a problem to be fixed, managed, and hidden. When considering new policy directions, we need to create capacity for a holistic menstrual policy landscape that overcomes systemic barriers to addressing the needs of menstruators that are largely rooted in menstrual stigma.

BackgroundPatient-centeredness is necessary for quality of care. Wide-spread incorporation of patient-centered practices across the health system is challenging in low and middle income countries (LMICs) given the complexity of scarce resources, competing priorities and rapidly changing social, economic and political landscapes. Health service managers and policy makers in these settings would benefit from a framework that allows comprehension and anticipation of forthcoming challenges for optimizing patient-centeredness in healthcare delivery. We set out to formulate such a framework, based primarily on analysis of general patterns of healthcare system evolution in LMICs and the current literature.DiscussionWe suggest that optimization of patient-centeredness in LMICs can be thought of as occurring in four phases, in accordance to particular patterns of macro transitions. Phase I is characterized by a deeply fragmented system based on conventional clinical approaches, dealing primarily with simple acute conditions. In phase II, the healthcare systems deal with increasing chronic cases and require redesign of existing acute-oriented services. In phase III, health services are increasingly confronted with multimorbid patients, requiring more coordinated and integrated care. Complex health care needs in individual patients are increasingly the norm in Phase IV, requiring the most optimal form of patient-centered care. This framework helps to identify and map the key challenges and implications for research, policy and practice, associated with the transitions ahead of time.SummaryWe have developed a framework based on observed patterns of healthcare and related macro-transitions in LMICs. The framework provides insights into critical issues to be considered by health service managers and policy makers.

Introduction Epidemiological data show that transgender women are disproportionately affected by Human Immunodeficiency Virus (HIV). Data in South Africa on the HIV vulnerabilities of transgender women are sparse. This paper qualitatively explores the structural, personal, and economic factors that contribute to making South African transgender women vulnerable to HIV and other sexually transmitted infections (STIs). Methods We conducted a rapid qualitative assessment in the Cape Town, Johannesburg, and Buffalo City metropolitan municipalities to frame the HIV risk vulnerabilities of transgender women. Purposive sampling was used to recruit study participants. We conducted 25 key informant interviews, five focus group discussions, and 26 in-depth interviews with transgender women. Atlas.ti.8 was used to facilitate qualitative data analysis. Study findings These data illustrate a pervasive theme of social rejection, discrimination, and everyday victimization among transgender women. The ubiquitous presence of stigma and rejection leads to internalized stigmatization, which affects the social and mental well-being of transgender women, who often turn to alcohol and illicit drug use to alleviate negative emotions. We found that transgender women may engage in high-risk sexual activities like sex work where they can express and affirm their gender identity. In this context, transgender women engaging in high-risk sexual activities found it challenging to access pre-exposure prophylaxis (PrEP). Stigma also leads to reluctance to use public healthcare services. Despite experiencing stigma and discrimination, qualitative data highlights the resilience of transgender women in the study. Conclusions Qualitative data demonstrate that HIV risk for transgender women is complex. Multi-level community-led interventions grounded in empowerment are also required to address interpersonal, biological, structural, and community risk. Successful interventions should address stigma and draw upon the resilience of transgender women. Peer-driven interventions may motivate personal responsibility to use high-impact HIV prevention and treatment services.