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

BACKGROUND: 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. OBJECTIVE: 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. DESIGN: Semi-structured, individual, qualitative interviews. PARTICIPANTS: Twenty-seven sexual and gender minority adults residing in Oregon. APPROACH: 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. CONCLUSIONS: 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.

"Little Tablets of Gold": An Examination of the Psychological and Social Dimensions of PrEP Among LGBTQ Communities.

There are significant psychological, social, and cultural dimensions to the HIV epidemic in the United States, especially among lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Biomedical HIV treatment has been shown to impact these dimensions. However, there is little understanding of the real-world psychosocial and sociocultural effects of the latest biomedical HIV prevention strategy, HIV pre-exposure prophylaxis (PrEP). This study explored the psychosocial and sociocultural dimensions of PrEP use among LGBTQ adults. We interviewed 23 LGBTQ adults who were current or former users of PrEP. Results included that PrEP users' experiences were shaped by multiple forms of stigma. Participants were highly motivated to challenge PrEP stigma and to support PrEP use among other community members. Lastly, participants described positive impacts on their individual well-being and their sexual partnerships. Findings suggest that PrEP has significant impacts beyond biomedical outcomes for both the individuals who use PrEP and their communities.