Policy and Procedural Barriers In PEP Access for Black and Latino Gay and Bisexual Male Sexual Assault Survivors

Introduction

PEP (Post-Exposure Prophylaxis) is a time-sensitive HIV prevention strategy for sexual assault survivors that must be initiated within 72 hours of exposure, and a full 28-day course is recommended. However, PEP completion rates among sexual assault survivors remain low (Ford et al., 2014). By law, hospitals are only required to provide at least a seven-day supply for PEP. Given the required 28 days needed to best prevent acquiring HIV, this can result in survivors not being able to complete the treatment course. Research has noted that male survivors are less likely to seek post-assault healthcare, and Black and Latino gay and bisexual male (GBM) survivors are even less likely to seek out sexual assault care despite being more likely to experience being sexually assaulted. Research has also found that LGBTQIA+ survivors are likely to experience barriers, such as racism and homophobia, when seeking medical care, which may further hinder their access to PEP. There is a lack of research on how these barriers affect PEP initiation and compliance. Researchers have further found that post-assault care for male survivors is scarce (Langdridge et al., 2023), let alone PEP access among Black and Latino GBM survivors. To address this gap, this study examines the barriers to accessing a full course of PEP among Black and Latino GBM survivors in the Boston area and how providers address this barrier in practice.

Methods

This qualitative study conducted individual, in-depth, one-on-one, semi-structured interviews with 24 healthcare providers and administrators in the greater Boston area who provide sexual assault services to survivors. The interviews focused on understanding health care policies and procedures for Black and/or Latino gay and bisexual men. All interviews were audio-recorded and transcribed verbatim. Thematic analysis guided our study, and the data analysis was consistent with this analysis.

Findings

Participants reported that Black and Latino GBM survivors often encounter procedural barriers to obtaining the full course of PEP after seeking medical care. The Massachusetts Victim Compensation Program provides financial support for PEP-related expenses; however, the upfront payment procedure creates a financial barrier, especially for survivors without insurance or who have limited finances. Additionally, many hospitals only provide a limited amount of PEP in the emergency department and require survivors to return for follow-up visits to receive the full supply. However, not all survivors schedule or attend follow-up visits, leading to incomplete PEP dosages.

Conclusion

Although programs to pay for PEP exist, many medical care systems require upfront payment, which places a financial burden on survivors, often resulting in missing PEP dosages and placing them at a higher risk for acquiring HIV. To address these barriers, providers should discuss available compensation programs, and refer survivors to pharmacies or clinics that offer a full course of PEP.