96. “I Just Wasn’t Getting What I Needed”: A Thematic Analysis of the Barriers Sexual and Gender Minority Youth (SGMY) Encountered Receiving Primary Care during the COVID-19 Pandemic

The COVID-19 pandemic has prompted the stretching of resources within the healthcare industry, limiting the workforce and inducing non-emergency care to adapt to virtual and telehealth options. For sexual and gender minority youth (SGMY), this disruption has the potential to create additional barriers to preventative and treatment medications in youth at-risk for or living with HIV. These disruptions to health-related services can lead to postponed primary care and treatment. This study aims to understand the pandemic’s effect on primary care receipt in a sample of SGMY recruited to participate in an online survey about COVID impact on health barriers. Participants who participated in the PUSH Study, a randomized control study, and were living in Baltimore, MD, Washington, DC, Philadelphia, PA, and Tampa, FL, were invited to complete a 30-minute online survey between July – November 2021 about the impact of COVID in their lives. Participants were also invited to join a one-on-one 45-minute in-depth interview (IDI) to further explore this impact. We used an explanatory mixed methods analysis to examine impact of COVID and barriers to receiving care during this time. Interviews were recorded, transcribed, and analyzed using inductive and deductive coding. Dedoose software was used to link interview responses to these codes. An iterative approach was used to produce a thematic analysis of interview responses. A total of 131 persons completed a COVID survey. Mean age of overall participants was 21.06 (SD 2.54); most (67%, n=85) were assigned-male-at-birth, identified as cisgender (79%, n=104), bisexual (44%, n=57) or gay (37%, n=48). Employment loss was common with (59%, n=75) reported loss of employment during COVID and (61%, n=77) reporting not being enrolled in school sometime during COVID. 35% (n=45) had postponed medical care, including general (74%), mental health (53%), STI (16%), HIV (11%). A purposive sample of participants (N=12) from Baltimore, Philadelphia, and Tampa were invited to complete an IDI about reasons for postponed care during COVID. We found that participants described encountering barriers and delays in care universally regardless of the care received. Four key themes emerged around barriers to receiving care: 1) Inability to receive in-person STI/HIV testing in SGMY-inclusive settings (experiencing stigma related to behavior); 2) Limited access to telehealth services; 3) Difficulty retrieving prescriptions; 4) Barriers to getting tested for COVID-19 (which delayed in-person care). Youth described having to be perseverant and resilient to receive needed care. Healthcare barriers were common in this sample, with youth describing barriers and delay in care with testing, telehealth, and receiving prescriptions. Despite barriers, SGMY became more proactive and displayed resilience to attain the services they sought. The perspectives from SGMY provided in this study can be used by healthcare providers to improve efficiency in the services, particularly telehealth, they provide. Potential solutions include multi-pronged strategies to improve technology used to communicate from provider to patient. By examining the quality assurance of these technologies, more streamlined delivery and increased reliability of services can be achieved. Future responses to emerging epidemics must also ensure access to SGMY-inclusive spaces.