“Do I want PrEP or do I want a roof?”: Social determinants of health and HIV prevention in the southern United States

ABSTRACT

Scaling up use of Pre-Exposure Prophylaxis (PrEP) among young men who have sex with men and transgender women (YMSM/TGW) is a critical part of the Ending the HIV Epidemic plan. This qualitative study contextualized the social determinants of health (SDOH) that can impede HIV prevention in rural North and South Carolina with 14 key informant interviews with stakeholders and 3 focus groups with YMSM/TGW (N = 23). A deductive-inductive approach with multiple coders was employed to identify themes related to SDOH in rural areas, including economic challenges (e.g., housing and food insecurity), neighborhood characteristics (e.g., lack of transportation), healthcare-related issues (e.g., provider shortages) and educational barriers (e.g., lack of comprehensive and inclusive sexual education). The socio-environmental context of the rural South and prioritization of local, community-based partnerships are necessary to reduce the burden of HIV.

KEYWORDS:

• HIV
• rural
• social determinants
• sexual and gender minority
• youth

Acknowledgments

We wish to express our gratitude to the individuals who took part in interviews and focus groups for this project to generously share their experiences and insights. We also wish to thank Eliza Schmidt for her assistance with literature review for this paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by grants from the National Institutes of Health, including the National Institute of Mental Health (K01MH118073). This research was funded in part through Developmental funding from the University of North Carolina at Chapel Hill (UNC-CH) Center for AIDS Research (CFAR), an NIH funded program P30 AI050410. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or UNC-CH CFAR.