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Sexual assault survivor policies vary widely across US states, which leads to unequal care. Under the Affordable Care Act (ACA), only women survivors are explicitly guaranteed affordable and comprehensive healthcare, including mental and physical health services. These institutional differences limit access to HIV prevention, such as post-exposure prophylaxis (PEP), and perpetuate disparities. Black and Latino Gay and bisexual men (GBM) who survive sexual assault face compounding barriers to care rooted in racism, homophobia, and a lack of trauma-informed, culturally responsive services. Gaps in provider training and insurance coverage further marginalized them. This study aims to examine institutional and structural barriers to healthcare and HIV prevention services for Black and Latino GBM survivors of sexual assault, based on perspectives from service providers in the Boston area.
METHODS
This qualitative study draws on in-depth interviews with staff and providers from community agencies and clinics in the Boston area that offer care and support services to sexual assault survivors. Semi-structured, individual, one-on-one interviews were conducted. All interviews were audio-recorded and transcribed verbatim. Content analysis guided our study, and data analysis was consistent with content analysis. All procedures received Institutional Review Board (IRB) approval.
RESULTS
Participants consistently reported a lack of formal protocols, best practice models, and institutional guidance tailored to Black and/or Latino GBM survivors. While agencies offered general services for survivors, only few had programs explicitly designed for GBM clients. Additionally, the lack of specialized training for clinicians working with GBM survivors renders service delivery highly dependent on individual providers’ knowledge, discretion, and personal comfort. Access to HIV/STI prevention services, such as PEP, also varied across organizations. No federal or state organizations were identified to support targeted PEP or health care provision for GBM survivors.
CONCLUSIONS AND IMPLICATIONS
Gay and bisexual men of color who have experienced sexual assault remain underserved due to fragmented systems of care and structural inequities. Expanding the ACA to explicitly include all survivors, regardless of sexual orientation or gender, is essential to ensuring access to PEP and trauma-informed care for GBM survivors. Sustained federal and state funding is needed for inclusive provider training, data collection on sexual orientation, and the development of institutional guidance on GBM survivor care. Locally, investment in more designated organizations and instituting LGBTQ-inclusive, trauma-informed protocols as standard care can advance equitable, responsive, and comprehensive care for this population.