Table 2.
Thematic analysis of pre-exposure prophylaxis (PrEP) uptake facilitators and barriers.
| Theme | Values, na | Participants’ quotes | ||||
| Theme 1: general PrEP uptake barriers (N=13) | ||||||
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Low self-perceived PrEP eligibility | 2 | “I’m not that interested in that pill because I don’t feel like I need it.” [IDI participant, Spanish, aged 22 years] | |||
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Intersectional stigma: gay, HIV, and PrEP related | 5 | “I hate to generalize, but I just feel like it’s worse in my culture, the Latino culture, than it is other cultures. They don’t understand the prevention aspect of it. So, they automatically assume you are HIV positive and, therefore, you are diseased, you’re dirty, you’re going to give it to them, you’re sexually fluid because you must be then gay, and that automatically, to them, means that you have no morals.” [IDI participant, English, aged 44 years] | |||
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Lack of insurance or perceived cost | 9 | “Because we’re in the US, everything is expensive, especially for those who don’t have papers or insurance. The problem is to afford the medication, it’s very expensive.” [IDI participant, Spanish, aged 45 years] | |||
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PrEP misconceptions, mostly related to side effects | 8 | “I’ve heard there are side effects, related to warts and I think a type of cancer.” [IDI participant, Spanish, aged 22 years] | |||
| Theme 2: PrEP uptake barriers that predominantly impact Latino SMMb (N=13) | ||||||
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Scarcity of trustworthy PrEP information sources, especially in Spanish | 7 | “I definitely see more advertisement about stuff like this in English. We are an English-speaking country, so I understand that. But even in like places that would be Spanish-speaking or Portuguese-speaking, I don’t see the advertisements for it. I wish there were more.” [IDI participant, English, aged 44 years] | |||
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Avoidance of PrEP-related discussions among peers | 6 | “I think we need more programs that focus on how we can talk among ourselves...it’s not very Latino to air out everything that’s going on in your personal life.” [IDI participant, Spanish, aged 30 years] | |||
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Challenges accessing existing sexual health services subcode | |||||
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Language barriers | 3 | “Payment, misinformation, and English barrier. You know? I think those would be the biggest issues.” [IDI participant, English, aged 36 years] | ||
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Assumed ineligibility for low-cost services because of undocumented status | 9 | “We have the issue of the legal status of the Latin community. So because of that, a lot of the guys that I know, sometimes because they don’t have a legal status inside the country, so they think they can’t have—they’re not allowed to have access to some prevention programs.” [IDI participant, English, aged 26 years] | ||
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Fear of immigration law enforcement and deportation | 6 | “You don’t want to try to help your health and then get locked up in jail or deported and separated from your family and friends. So, you’d rather just not even talk about it or do it or go to it.” [IDI participant, English, aged 44 years] | ||
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Competing work obligations | 6 | “We work a lot when we’re here,...when the clinics are open, they can’t go, because they can’t just ask for a day off. You make $400.00 a week, and you need to skip a day to go see a doctor, and your boss is going to say like this. So why are you going to see a doctor? Oh, I want to take PrEP. It’s not because you’re sick or something. They’re going to say no.” [IDI participant, English, aged 36 years] | ||
| Theme 3: PrEP uptake facilitators (n=7) | ||||||
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Knowing a health care provider who has familiarity providing PrEP | 2 | “I spent like one or two years with one or two doctors who didn’t know about PrEP, until I finally found a doctor who knew and he was the one who helped me.” [IDI participant, Spanish, aged 45 years] | |||
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Having a health care provider is part of LGBTQIA+c groups or ally | 1 | “She just immediately told me, ‘I just want you to know I’m an ally and I have many gay friends and I grew up with gay people. So, I want you to know you’re safe with me. You’re comfortable. I think it’s excellent that you want to learn more about the medication and get on it and I’m going to help you do that.’ So, she did.” [IDI participant, English, aged 44 years] | |||
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Having a health care provider who’s a Latino | 1 | “I think most people would agree that they would feel more comfortable if the person actually was Latino as well.” [IDI participant, English, aged 44 years] | |||
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Trust in health care providers’ opinions on PrEP eligibility and safety | 3 | “It’s not the same if the person who’s telling you (the information) is someone who heard it from someone else, than a doctor who learned this from another doctor.” [IDI participant, Spanish, aged 36 years] | |||
aThe n values in this column reflect the number of participants whose response was captured by the associated subcode within each theme. The total n of this column may exceed the total N for each theme because some participants offered responses to multiple subcodes.
bSMM: sexual minority men.
cLGBTQIA+: lesbian, gay, bisexual, transgender, queer, intersex, and asexual.