Access to HIV Pre-exposure Prophylaxis in Practice Settings: a Qualitative Study of Sexual and Gender Minority Adults’ Perspectives

  • Christina J. SunEmail author
  • Kirsten M. Anderson
  • David Bangsberg
  • Kim Toevs
  • Dayna Morrison
  • Caitlin Wells
  • Pete Clark
  • Christina Nicolaidis



Sexual and gender minority (SGM) populations remain at disproportionate risk of HIV infection. Despite the effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV, PrEP uptake has been slow.


To identify barriers and facilitators of PrEP access by examining SGM patients’ experiences with accessing health care systems and engaging with providers about PrEP in a variety of practice settings.


Semi-structured, individual, qualitative interviews.


Twenty-seven sexual and gender minority adults residing in Oregon.


Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

Key Results

We identified three main themes. Participants described the centrality of patient-provider relationships to positive experiences around PrEP, the necessity of personally advocating to access PrEP, and the experience of system-level barriers to PrEP access. Participants also made several suggestions to improve PrEP access including improving provider engagement with SGM patients, encouraging providers to initiate conversations about PrEP, and increasing awareness of medication financial support.


In order to reduce HIV disparities, improving PrEP access will require additional efforts by providers and resources across health care settings to reduce barriers. Interventions to improve provider education about PrEP and provider communication skills for discussing sexual health are needed. Additionally, there should be system-level improvements to increase coordination between patients, providers, pharmacies, and payers to facilitate PrEP access and uptake.


prevention HIV/AIDS qualitative research patient preferences doctor-patient relationships 



We thank the participants and the nPEP/PrEP stakeholder group, particularly Miguel D. Carreon, FNP-C, DNP, for their insights and expertise that greatly assisted the research.

Funding Information

This project was supported by Oregon AIDS Education and Training Center at Portland Veterans Affairs Research Foundation and grant number K12HS022981 from the Agency for Healthcare Research and Quality.

Compliance with Ethical Standards

The Portland State University Institutional Review Board approved this study.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


The content is solely the responsibility of the authors and does not necessarily represent the official views of the Oregon AIDS Education and Training Center at Portland Veterans Affairs Research Foundation and Agency for Healthcare Research and Quality.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Christina J. Sun
    • 1
    Email author
  • Kirsten M. Anderson
    • 1
  • David Bangsberg
    • 1
  • Kim Toevs
    • 2
  • Dayna Morrison
    • 3
  • Caitlin Wells
    • 4
  • Pete Clark
    • 2
  • Christina Nicolaidis
    • 1
    • 5
    • 6
  1. 1.Oregon Health & Science University-Portland State University School of Public HealthPortlandUSA
  2. 2.Multnomah County Health DepartmentPortlandUSA
  3. 3.Oregon AIDS Education and Training Center at Portland Veterans Affairs Research FoundationPortlandUSA
  4. 4.Cascade AIDS ProjectPortlandUSA
  5. 5.Portland State University School of Social WorkPortlandUSA
  6. 6.Oregon Health & Science University School of MedicinePortlandUSA

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