Table 1.

Barriers and Facilitators to access and uptake of PrEP among sexual and gender minority Latinxs living in the U.S.

Level	Barriers	Facilitators
Structural	Lack of health insurance Ineffective patient-provider communication Low health literacy Limited English proficiency Setting Undocumented Economic hardship Housing Lack of occupational protections	Free or low-cost care- the Ryan White model (including mental health care) Gilead Patient Assistance Program FQHC Dental and vision care, substance use disorder care, housing, transportation and employment assistance. Medical interpreters Peer navigation U-visas for victims of crime Asylum for persecuted gender minorities Medico-legal collaborations
Community	Low awareness of PrEP	Leveraging clinics that are providing HIV testing. Client information material Community educational material Culturally competent staff Peer navigators (promotores/as) Peer networks Support groups Social marketing
Individual	Concerns about side effects Hesitancy to discuss sexual health with provider Medical mistrust HIV stigma Discrimination, social rejection, isolation Depression, anxiety, alcohol and substance abuse Acculturation challenges Trauma (gang violence) Note: unique barriers for transgender Latinx are largely unknown.	Culturally sensitive care that addresses specific medical needs and concerns of Latinx, LGBT and recent immigrant populations, and their impact on mental health and wellbeing Registration forms that address needs of gender and sexual minorities and concerns of undocumented immigrants.