Skip to main content

Advertisement

SpringerLink
Log in

Provider Perspectives on Multi-level Barriers and Facilitators to PrEP Access Among Latinx Sexual and Gender Minorities

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Although pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention intervention, inequities in access remain among Latinx sexual and gender minorities (LSGM). There is also a gap in the PrEP literature regarding providers’ perspective on access inequities. This qualitative case study sought to explore barriers and facilitators to PrEP engagement in a community-based integrated health center primarily serving Latinx populations in Northern California. We conducted in-depth, semi-structured interviews with providers (9/15) involved in PrEP services and engaged in a constructivist grounded theory analysis consisting of memoing, coding, and identifying salient themes. Three participants worked as medical providers, three as outreach staff, and one each in planning, education, and research. The analysis surfaced four themes: geopolitical differences, culture as barrier, clinic as context, and patient strengths and needs. Participants referenced a lack of resources to promote PrEP, as well as the difficulties of working within an institution that still struggles with cultural and organizational mores that deprioritize sexual health. Another barrier is related to sexual health being positioned outside of patients’ immediate needs owing to structural barriers, including poverty, documentation status, and education. Participants, however, observed that peer-based models, which emboldened their decision-making processes, were conducive to better access to PrEP, as well as allowing them to build stronger community ties. These data underscore the need for interventions to help reduce sexual stigma, promote peer support, and ameliorate structural barriers to sexual healthcare among LSGM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

Not applicable.

Code Availability

Not applicable.

References

  1. Mera Giler, et al., “Changes in Truvada (TVD) for HIV pre-exposure prophylaxis (PrEP) utilization in the United States:(2012–2016).,” presented at the In 9th International AIDS society conference on HIV science (pp. 23–26), 2017.

  2. Smith DK, Van Handel M, Grey J. Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015. Ann Epidemiol. 2018. https://doi.org/10.1016/j.annepidem.2018.05.003.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Golub SA. PrEP Stigma: implicit and explicit drivers of disparity. Curr HIV/AIDS Rep. 2018;15(2):190–7. https://doi.org/10.1007/s11904-018-0385-0.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Harkness A, et al. Scaling up and out HIV prevention and behavioral health services to latino sexual minority men in South Florida: multi-level implementation barriers, facilitators, and strategies. AIDS Patient Care STDS. 2021;35(5):167–79. https://doi.org/10.1089/apc.2021.0018.

    Article  PubMed  PubMed Central  Google Scholar 

  5. “Volume 28 Number 4| HIV Surveillance | Reports | Resource Library | HIV/AIDS | CDC.” Accessed: Jan. 30, 2024. [Online]. Available: https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-28-no-4/index.html

  6. “HIV Surveillance | Reports| Resource Library | HIV/AIDS | CDC.” Accessed: Jan. 30, 2024. [Online]. Available: https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html

  7. Gómez W. Assessing PrEP messaging and communication: a review of the qualitative literature. Curr Opin Psychol. 2023;51:101586. https://doi.org/10.1016/j.copsyc.2023.101586.

    Article  PubMed  Google Scholar 

  8. Dubov A, Galbo P, Altice FL, Fraenkel L. Stigma and shame experiences by MSM who take PrEP for HIV prevention: a qualitative study. Am J Mens Health. 2018;12(6):1843–54. https://doi.org/10.1177/1557988318797437.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pawson M, Grov C. ‘It’s just an excuse to slut around’: gay and bisexual mens’ constructions of HIV pre-exposure prophylaxis (PrEP) as a social problem. Sociol Health Illn. 2018;40(8):1391–403. https://doi.org/10.1111/1467-9566.12765.

    Article  PubMed  Google Scholar 

  10. Przeworski A, Piedra A. The role of the family for sexual minority latinx individuals: a systematic review and recommendations for clinical practice. J GLBT Fam Stud. 2020;16(2):211–40. https://doi.org/10.1080/1550428X.2020.1724109.

    Article  Google Scholar 

  11. D Sanchez KM Wagner E Hamilton M Singletary 2023 “Where you learn about sex matters: sexual information sources during adolescence and current sexual values and sexual behaviors in Latinx emerging adults”, J Lat Psychol, No Pagination Specified-No Pagination Specified https://doi.org/10.1037/lat0000233

  12. Frank L, et al. HIV PrEP implementation: a multi-level systems approach. Eval Program Plann. 2022;90:101966. https://doi.org/10.1016/j.evalprogplan.2021.101966.

    Article  PubMed  Google Scholar 

  13. Zapata JP, de St. Aubin C, Rodriguez-Diaz CE, Malave-Rivera S. Using a structural-ecological model to facilitate adoption of preexposure prophylaxis among Latinx sexual minority men: a systematic literature review. J Lat Psychol. 2022;10(3):169–90. https://doi.org/10.1037/lat0000204.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Baah FO, Teitelman AM, Riegel B. Marginalization: conceptualizing patient vulnerabilities in the framework of social determinants of health—An integrative review. Nurs Inq. 2019;26(1):e12268. https://doi.org/10.1111/nin.12268.

    Article  PubMed  Google Scholar 

  15. Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. In: The Social Determinants of Health: Coming of Age. Duke University Press; 2019. p. 134–55. https://doi.org/10.1515/9781478004363-022.

    Chapter  Google Scholar 

  16. Hill-Briggs F, et al. Social determinants of health and diabetes: a scientific review. Diabetes Care. 2021;44(1):258–79. https://doi.org/10.2337/dci20-0053.

    Article  Google Scholar 

  17. Pleuhs B, Quinn KG, Walsh JL, Petroll AE, John SA. Health care provider barriers to HIV pre-exposure prophylaxis in the United States: a systematic review. AIDS Patient Care STDS. 2020;34(3):111–23. https://doi.org/10.1089/apc.2019.0189.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Brooks RA, Nieto O, Cabral A, Landrian A, Fehrenbacher AE. Delivering PrEP to adults with ‘low’ or ‘no’ HIV risk and youth: experiences and perspectives of PrEP providers. Cult Health Sex. 2022;24(1):95–108. https://doi.org/10.1080/13691058.2020.1817560.

    Article  Google Scholar 

  19. Bonacci RA, Smith DK, Ojikutu BO. Toward greater pre-exposure prophylaxis equity: increasing provision and uptake for black and hispanic/latino individuals in the U.S. Am J Prev Med. 2021;61(5, Supplement 1):S60–72. https://doi.org/10.1016/j.amepre.2021.05.027.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. SAGE; 2006.

    Google Scholar 

  21. Strauss A, Corbin J. “Grounded theory methodology”, in Handbook of Qualitative Research. Thousand Oaks, CA, US: SAGE Publications; 1994. p. 273–85.

    Google Scholar 

  22. Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach. BMC Med Res Methodol. 2011;11(1):100. https://doi.org/10.1186/1471-2288-11-100.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Apramian T, Cristancho S, Watling C, Lingard L. (Re) Grounding grounded theory: a close reading of theory in four schools. Qual Res. 2017;17(4):359–76.

    Article  Google Scholar 

  24. Rieger KL. Discriminating among grounded theory approaches. Nurs Inq. 2019;26(1):e12261. https://doi.org/10.1111/nin.12261.

    Article  MathSciNet  PubMed  Google Scholar 

  25. Reback CJ, Clark KA, Rünger D, Fehrenbacher AE. A promising PrEP navigation intervention for transgender women and men who have sex with men experiencing multiple syndemic health disparities. J Community Health. 2019;44(6):1193–203. https://doi.org/10.1007/s10900-019-00705-x.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Reback CJ, Kisler KA, Fletcher JB. A novel adaptation of peer health navigation and contingency management for advancement along the HIV care continuum among transgender women of color. AIDS Behav. 2021;25(1):40–51. https://doi.org/10.1007/s10461-019-02554-0.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Golub SA, Meyers K, Enemchukwu C. Perspectives and recommendations from lesbian, gay, bisexual, transgender, and queer/questioning youth of color regarding engagement in biomedical HIV prevention. J Adolesc Health. 2020;66(3):281–7. https://doi.org/10.1016/j.jadohealth.2019.09.016.

    Article  PubMed  Google Scholar 

  28. A. A. Khryanin, X. A. Aлeкceeвич, T. A. Shpiks, Ш. T. Aлeкcaндpoвнa, M. V. Russkikh, and P. M. Bиктopoвнa, “Comparative analysis of sexual behavior and assessment of awareness of STIs and HIV infection among young people of two generations,” Vestnik dermatologii i venerologii;98(6):6, 2022, https://doi.org/10.25208/vdv1379.

  29. Doblecki-Lewis S, Butts S, Botero V, Klose K, Cardenas G, Feaster D. A randomized study of passive versus active PrEP patient navigation for a heterogeneous population at risk for HIV in South Florida. J Int Assoc Provid AIDS Care. 2019;18:2325958219848848. https://doi.org/10.1177/2325958219848848.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sang JM, et al. Examining associations between resilience and PrEP use among HIV-negative GBM in Toronto, Montreal and Vancouver. AIDS Behav. 2023;27(9):3109–21. https://doi.org/10.1007/s10461-023-04031-1.

    Article  PubMed  Google Scholar 

  31. Raifman JR, et al. Brief report: pre-exposure prophylaxis awareness and use among cisgender women at a sexually transmitted disease clinic. J Acquir Immune Defic Syndr. 2019;80(1):36–9. https://doi.org/10.1097/QAI.0000000000001879.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Batchelder AW, Carrico AW, Acree M, Hecht FM, Moskowitz JT. Positive and negative self-conscious emotion and transmission risk following HIV diagnosis. AIDS Behav. 2018;22(5):1496–502. https://doi.org/10.1007/s10461-017-1943-y.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Carrico AW, et al. Randomized controlled trial of a positive affect intervention for methamphetamine users. Drug Alcohol Depend. 2018;192:8–15. https://doi.org/10.1016/j.drugalcdep.2018.07.029.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Carrico AW, et al. Randomized controlled trial of a positive affect intervention to reduce HIV viral load among sexual minority men who use methamphetamine. J Int AIDS Soc. 2019;22(12):e25436. https://doi.org/10.1002/jia2.25436.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Moskowitz JT, et al. Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. J Consult Clin Psychol. 2017;85(5):409–23. https://doi.org/10.1037/ccp0000188.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hojilla JC, et al. Characterization of HIV preexposure prophylaxis use behaviors and HIV incidence among US adults in an integrated health care system. JAMA Netw Open. 2021;4(8):e2122692. https://doi.org/10.1001/jamanetworkopen.2021.22692.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Marcus JL, et al. Preexposure prophylaxis for HIV prevention in a large integrated health care system: adherence, renal safety, and discontinuation. J Acquir Immune Defic Syndr. 2016;73(5):540–6. https://doi.org/10.1097/QAI.0000000000001129.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Guilamo-Ramos V, et al. A triadic intervention for adolescent sexual health: a randomized clinical trial. Pediatrics. 2020;145(5):e20192808. https://doi.org/10.1542/peds.2019-2808.

    Article  PubMed  Google Scholar 

  39. Kimball AA, et al. The effect of navigation on linkage to a PrEP provider among PrEP-eligible men who have sex with men in a U.S. demonstration project. AIDS Behav. 2023;27(6):1981–8. https://doi.org/10.1007/s10461-022-03931-y.

    Article  PubMed  Google Scholar 

  40. Nieto O, Brooks RA, Landrian A, Cabral A, Fehrenbacher AE. PrEP discontinuation among Latino/a and Black MSM and transgender women: a need for PrEP support services. PLoS ONE. 2020;15(11):e0241340. https://doi.org/10.1371/journal.pone.0241340.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Gόmez W, et al. Optimizing contingency management with methamphetamine-using men who have sex with men. Cogn Behav Pract. 2018;25(2):286–95. https://doi.org/10.1016/j.cbpra.2017.08.003.

    Article  PubMed  Google Scholar 

  42. Mitchell JT, et al. Smartphone-based contingency management intervention to improve pre-exposure prophylaxis adherence: pilot trial. JMIR Mhealth Uhealth. 2018;6(9):e10456. https://doi.org/10.2196/10456.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Mitchell JT, et al. Feasibility, acceptability, and preliminary efficacy of a gamified mobile health contingency management intervention for PrEP adherence among black MSM. AIDS Behav. 2022;26(10):3311–24. https://doi.org/10.1007/s10461-022-03675-9.

    Article  PubMed  Google Scholar 

  44. Shearer NBC. Health empowerment theory as a guide for practice”. Geriatr Nurs. 2009;30(2 Suppl):4–10. https://doi.org/10.1016/j.gerinurse.2009.02.003.

    Article  PubMed  Google Scholar 

  45. Lin S-C, Chen I-J, Yu W-R, Lee S-YD, Tsai T-I. Effect of a community-based participatory health literacy program on health behaviors and health empowerment among community-dwelling older adults: a quasi-experimental study. Geriatr Nurs. 2019;40(5):494–501. https://doi.org/10.1016/j.gerinurse.2019.03.013.

    Article  PubMed  Google Scholar 

  46. Tucker CM, Roncoroni J, Wippold GM, Marsiske M, Flenar DJ, Hultgren K. Health self-empowerment theory: predicting health behaviors and BMI in culturally diverse adults. Fam Community Health. 2018;41(3):168. https://doi.org/10.1097/FCH.0000000000000195.

    Article  PubMed  Google Scholar 

  47. Ni L, De la Flor M, Wang Q, Romero V. Engagement in context: making meaning of the Latino community health engagement process. Public Relations Review. 2021;47(2):102036. https://doi.org/10.1016/j.pubrev.2021.102036.

    Article  Google Scholar 

  48. G. Watts and H. Vaughan, “Efforts targeting factors of health disparities that impair HIV treatment engagement,” Florida Public Health Review;16(1), 2019, [Online]. Available: https://digitalcommons.unf.edu/fphr/vol16/iss1/12

  49. Wilson TE, et al. Healthcare empowerment and HIV viral control: mediating roles of adherence and retention in care. Am J Prev Med. 2018;54(6):756–64. https://doi.org/10.1016/j.amepre.2018.02.012.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Supported by grant funding from Gilead Sciences, Inc.

Author information

Authors and Affiliations

  1. Jane Addams College of Social Work, University of Illinois Chicago, 1040 West Harrison Street (MC309), Chicago, IL, 60607-7134, USA

    Walter Gómez & Cheryl Dimonte

  2. School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA

    Anu Manchikanti Gomez, Sheilalyn Solis & Kurt C. Organista

Authors
  1. Walter Gómez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anu Manchikanti Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sheilalyn Solis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheryl Dimonte
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kurt C. Organista
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study’s concept, design, and/or manuscript development, as well as approving the manuscript’s final version.

Corresponding author

Correspondence to Walter Gómez.

Ethics declarations

Ethics Approval

All study activities were approved by the University of California, Berkeley’s Institutional Review Board.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

The authors affirm that human research participants provided informed consent for publication.

Competing interests

Gilead Sciences, Inc. has had no input into the development or content of these materials.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix. Interview guide

Appendix. Interview guide

Introduction

  1. 1.

    Could you tell me a bit about your role here at the clinic?

    1. a.

      How long have you worked here?

    2. b.

      Was this always your position?

  2. 2.

    Could you briefly describe your team and your role in it?

Population

  1. 1.

    Do you work with a particular population or community?

  2. 2.

    What would you say is your affinity towards this population/community?

    1. a.

      Does that make your job easier?

  3. 3.

    What would you say are this population/community’s most pressing needs?

    1. a.

      Do you feel well-supported to address those needs?

HIV and PrEP

  1. 1.

    How long have you been working in the field of sexual health?

    1. a.

      What got you into it?

  2. 2.

    How would you describe your HIV knowledge?

    1. a.

      Where did you gain access to this knowledge?

  3. 3.

    When did you become aware of PrEP?

    1. a.

      Where did you gain access to this information?

  4. 4.

    When did the clinic start addressing PrEP?

  5. 5.

    Could you briefly describe your particular role in PrEP outreach, education and/or counseling?

PrEP and Community

  1. 1.

    What would you say are the most prevalent barriers for your population to access PrEP?

  2. 2.

    Do you feel they have the most accurate and up-to-date information around PrEP?

  3. 3.

    Who do you feel should be responsible for promoting this information?

  4. 4.

    Who do you feel should be responsible for expanding access to PrEP?

  5. 5.

    Where do you think culture fits in these gaps in access?

    1. a.

      How could we bridge these gaps?

  6. 6.

    Where do you think finances fit in these gaps in access?

    1. a.

      How could we bridge these gaps?

Conclusion

  1. 1.

    Is there anything you would like to add or revisit?

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gómez, W., Gomez, A.M., Solis, S. et al. Provider Perspectives on Multi-level Barriers and Facilitators to PrEP Access Among Latinx Sexual and Gender Minorities. J. Racial and Ethnic Health Disparities (2024). https://doi.org/10.1007/s40615-024-01948-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40615-024-01948-8

Keywords

Search

Navigation