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

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.