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. Author manuscript; available in PMC: 2022 Apr 5.
Published in final edited form as: J Assoc Nurses AIDS Care. 2022 Jan-Feb;33(1):9–21. doi: 10.1097/JNC.0000000000000280

Table 1.

Barriers and Facilitators to Health Care Access During COVID-19 With Example Quotations

Categories/Themes BH Test PrEP PEP HIV Care ART Example Quotation
1. COVID-19 Safety and Precautions in Health Care Settings
Fear of COVID-19 exposure or transmission to others X X X X X I think contact with others is affecting going to get HIV tests. Seeing a doctor implies you will be exposed to contact with a lot more people, which is the fear. This fear has made people not go to clinics, be more afraid of testing, they are waiting for things to pass, like me, to get their tests done. White Latinx gay man without HIV, late 30s, non-U.S.-born
COVID-19 safety measures are in place X X X X It would have to be something similar to what my job is doing - a controlled environment so that there is a limited amount of exposure…then I think that would make me feel extremely comfortable. White Latinx gay man living with HIV, early 30s, U.S.-born
2. Perceived Need for Services
Lack of perceived need for services X X X X You know Just trying to stay home. I didn’t find it urgent, on the front burner, of things I had to do. Just trying to stay safe home. White Latinx gay man living with HIV, early 30s, U.S.-born
High perceived need for services X X X X X X I need to keep up those [ART] refills, even if he would have forced me to go in I would have gone. White Latinx gay man living with HIV, mid 20s, U.S.-born
3. Knowledge of How and Where to Get Services During COVID-19
Lack of knowledge about where or how to get services during COVID-19 X X X X Before it was hard to access and find the right resources, now it’s even worse because you’re not sure which ones are open or which ones are doing it from home. There’s a lot of changes that may not be reflected on the websites or the right information may not be available at the moment because it happened so fast. White Latinx gay man without HIV, mid 20s, non-U.S.-born
COVID-19 caused disruptions to usual service delivery X X X X It was so difficult to go through the system that I used [to get behavioral health services], not impossible, but it was very complex, there were too many hurdles. White Latinx gay man living with HIV, late 50s, non-U.S.-born
Access to information and support in navigating the health care system X X Getting to know that they’re taking my information, or if they’re currently not operating just to know what other things can I do, what other services can I do, what other services can I reach to? White Latinx gay man without HIV, mid 20s, non-U.S.-born
Continued engagement in services from before COVID-19 X X X I still had [PrEP] pills, so I didn’t have the need to text or have an appointment via telemedicine with my doctor. White Latinx gay man without HIV, mid 20s, non-U.S.-born
4. Trust and Confidence in Health Care Providers
Privacy concerns X X Let’s say you get medication delivered to your home, it would have to be a very hush hush thing because you don’t want your family, or your neighbors, or your friends to know about it because some people are very secretive about it. White Latinx gay man without HIV, late teens, non-U.S.-born
Discomfort with telehealth X I would do all my appointments remotely...except therapy. White Latinx gay man living with HIV, mid 20s, U.S.-born
LGBTQ-affirming culturally relevant, trustworthy, warm providers and organizations X X X X X I feel they [company that provides remote PrEP care] have been reliable so far. I kind of trust them in a way, so they’ve built a trustworthy relationship. White Latinx gay man without HIV, late teens, non-U.S.-born
5. Structural Issues
Financial or insurance barriers exacerbated during COVID-19 X X Problems with insurance probably. Not being able to know what’s covered by insurance and what’s not. Especially with unemployment rates going higher and higher, people [are] not wanting to spend money on these types of [HIV-prevention] services. White Latinx gay man without HIV, early 20s, U.S.-born
Structural barriers are addressed X X During COVID-19, Miami transportation is free so that would make it easier [to get services]. White Latinx gay man without HIV, early 20s, U.S.-born
6. Service Delivery Models
Remote service delivery options may facilitate LSMM’s access X X X X X X It’s more comfortable to have her talk to me via telehealth, in terms of that. I mean if she has already done a physical exam for me, I think there’s no specific reason why I would have to physically go to the visit. White Latinx gay man without HIV, mid 20s, non-U.S.-born
Relaxing and adapting protocols to enhance service delivery X X The pharmacy just called me and told me I was about to run out of medication, I didn’t have to go my doctors’ office to get a new prescription. It was just faxed over to the pharmacy and I got my refills. Before I had to go the doctor’s, office pick up a paper, and take it to the pharmacy. White Latinx gay man living with HIV, early 30s, non-U.S.-born

Note. Codes apply to services (BH = behavioral health treatment, test = HIV testing, PrEP, PEP, HIV care, ART medication) marked with an “x.”

ART indicates antiretroviral therapy; COVID-19, coronavirus disease 2019; LGBTQ, lesbian, gay, bisexual, transgender, queer or questioning; LSMM, Latinx sexual minority men; PEP, post-exposure prophylaxis; and PrEP, pre-exposure prophylaxis.

HHS Vulnerability Disclosure