Ecological barriers to HIV service access among young men who have sex with men and high-risk young women from low-resourced urban communities

Abstract

Using an ecological perspective, we sought to elucidate the perceived barriers preventing HIV service access among two groups of U.S. youth (ages 12–24) disproportionately affected by HIV, men who have sex with men, and high-risk women. We content analyzed interviews with 318 key informants to identify distinct service access barriers. The 29 barriers informants named were organized into six categories (service-seeking demands, stigmas, knowledge and awareness, service quality, powerful opposition, and negative emotions). Findings suggest that barriers impacting access to HIV prevention, testing, and linkage-to-care services are remarkably similar and point to the need for comprehensive approaches to improving youth’s access services that address both individual-level barriers and extra-individual barriers simultaneously. Findings can be used to guide future research, programming, and interventions to reduce the disproportionate spread of HIV among U.S. youth.

Keywords:

• adolescents and young adults
• HIV service access
• service barriers
• youth-responsive services

Additional information

Funding

This work was supported by The Adolescent Trials Network for HIV/AIDS Interventions (ATN) with funding from the National Institutes of Health [U01 HD 040533 and U01 HD 040474] through the National Institute of Child Health and Human Development (B. Kapogiannis), with supplemental funding from the National Institutes on Drug Abuse (S. Kahana) and Mental Health (P. Brouwers, S. Allison). We acknowledge the contribution of the investigators and staff at the following Adolescent Medicine Trials Units (AMTUs) that participated in this research: Children’s Hospital of Los Angeles (Marvin Belzer, MD, Miguel Martinez, MSW/MPH, Julia Dudek, MPH, Milton Smith, BA); John H. Stroger Jr. Hospital of Cook County and the CORE Center (Lisa Henry-Reid, MD, Jaime Martinez, MD, Ciuinal Lewis, MS, Atara Young, MS, Jolietta Holliman, Antoinette McFadden, BA); Children’s Hospital National Medical Center (Lawrence D’Angelo, MD, William Barnes, PhD, Stephanie Stines, MPH, Jennifer Sinkfield, MPH) Montefiore Medical Center (Donna Futterman, MD, Bianca Lopez, MPH, Elizabeth Spurrell, MPH, LCSW, Rebecca Shore, MPH); Tulane University Health Sciences Center (Sue Ellen Abdalian, MD, Nadrine Hayden, BS; St. Jude Children’s Research Hospital (Patricia Flynn, MD, Aditya Guar, MD, Andrea Stubbs, MPH); University of Miami School of Medicine (Lawrence Friedman, MD, Kenia Sanchez, MSW); Children's Hospital of Philadelphia (Steven Douglas, MD, Bret Rudy, MD, Marne Castillo, PhD, Alison Lin, MPH); University of South Florida (Patricia Emmanuel, MD, Diane Straub, MD, Amanda Schall, MA, Rachel Stewart-Campbell, BA; Cristian Chandler, MPH, Chris Walker, MSW); Baylor College of Medicine, Texas Children’s Hospital (Mary Paul, MD, Kimberly Lopez, DrPH; Wayne State University (Elizabeth Secord, MD, Angulique Outlaw, MD, Emily Brown, MPP); Johns Hopkins University, School of Medicine (Allison Agwu, MD, Renata Sanders, MD, Marines Terreforte, MPA); The Fenway Institute (Kenneth Mayer, MD, Liz Salomon, EdM, Benjamin Perkins, MA, M.Div.); and University of Colorado (Daniel Reirdan, MD, Jamie Sims, MSW, Moises Munoz, BA). We appreciate the scientific review provided by members of the Community Prevention Leadership Group of the ATN. We are also grateful to the ATN Coordinating Center at the University of Alabama (Craig Wilson, MD; Cynthia Partlow, MEd, and Jeanne Merchant, MPH) who provided scientific and administrative oversight; the ATN Data and Operations Center at Westat, (James Korelitz, PhD, Barbara Driver, RN, Rick Mitchell MS, and Marie Alexander, BS) who provided operations and analytic support to the ATN; and the National Coordinating Center at Johns Hopkins University, Department of Pediatrics (Jessica Roy, MSW, Rachel Stewart-Campbell, MA, MPH) who provided national-level oversight, technical assistance, and staff training, and Dina Monte (Westat) who served as the protocol specialist. The comments and views of the authors do not necessarily represent the views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The investigators are grateful to the members of the local youth Community Advisory Boards for their insight and counsel and are indebted to the youth and adult community informants who participated in this study.