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’ perspectives on access inequities. These topics are explored in a new paper published in the Journal of Racial and Ethnic Health Disparities by Walter Gómez, PhD, MA, MSW, an affiliate member of the Third Coast CFAR.

Walter Gómez
Walter Gómez, PhD

An important step in achieving health equity among multiple marginalized communities, such as LSGM, is reframing power dynamics that serve as barriers to positive outcomes. By engaging in a multi-level perspective and eliciting providers’ accounts, this study’s findings underscore the importance of reallocating the burden of PrEP access and HIV incidence in these high priority populations beyond the individuals and communities and onto institutions and structures of care.

“A common assessment among this sample was the necessity of care settings to support community-building efforts, genuinely and consistently,” said Gómez, an assistant professor of the Jane Addams College of Social Work at the University of Illinois Chicago. “Community-building worked in tandem with trust-building, which respondents relayed could take shape in different ways and settings. Community-building and trust-building stimulate more welcoming environments and foster affinity mining, which is a way to build connections between providers and patients who may share similar lived experiences. Providers supporting patients who may feel less connected to medical settings is a strategy consistent with existing literature on HIV prevention with marginalized groups.”

This qualitative case study sought to examine barriers and facilitators to PrEP engagement in a community-based integrated health center primarily serving LSGM populations in Northern California. Gómez and his research team conducted in-depth, semi-structured interviews with providers involved in PrEP services and engaged in a constructivist grounded theory analysis consisting of memoing, coding, and identifying salient themes. The researchers identified four themes: geopolitical differences, culture as barrier, clinic as context, and patient strengths and needs.

In the study, providers 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 found was sexual health not considered among patients’ immediate needs due to structural barriers, including poverty, documentation status, and education. Providers, 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.

This study emphasizes the need for PrEP interventions to help reduce sexual stigma, promote peer support, and remove structural barriers to sexual healthcare among LSGM.