Delayed Pursuit of Health Care Among HIV-Positive Gay Men Enrolled in a Longitudinal Research Study

Abstract

The aim of this qualitative article is to describe the reasons HIV-positive gay men who are enrolled in a longitudinal research project give for not initiating health care. Extreme sampling techniques were used to recruit four HIV-positive gay men who are enrolled in a research project that is examining factors related to disease progression in HIV infection but who do not otherwise receive any health care. Intensive, open-ended interviews were conducted, and the interviews were analyzed for recurring themes. Results indicate that the participants did not have an accurate perception of health care and therefore were hesitant in seeking health care. Part of this hesitation involved their strong reluctance to begin antiretroviral therapy. Enrollment in a longitudinal study allowed the participants to have some monitoring of their HIV infection. However, not having a primary care provider resulted in a lack of preparedness when they encountered changes in their health status. The end result of this process was progression in their HIV disease. Implications for clinicians and researchers are discussed.

Medication-Related Barriers to Entering HIV Care

“…In a longitudinal study of a small number of gay men who had not entered HIV care, researchers found that reluctance to receive ART, concerns about side effects, and mistrust of medical care providers affected engagement in care. 12 These factors, along with a preference for traditional healers rather than medical staff, were associated with suboptimal health care utilization among HIVinfected Zambians. 26 Our analysis supports the limited work in this area in that it also finds that concerns about medications and health care providers are common, and extends it by articulating the pathways through which fears about medications are related to decisions to not enter care.…”

“…For example, studies have documented reluctance to take ART and fears about medication side effects. [10][11][12][13][14][15][16][17] However, because almost all studies have focused on HIV-infected persons already engaged in medical care, little is known about how medication-related factors influence prospective decisions to enter care. 18,19 An important exception is a recent study by Pollini and colleagues 20 who found that, compared to those in care, persons who had never initiated HIV care were more likely to mistrust HIV medications and health care providers.…”

The state of men’s health in Western Europe

“…Across a broad band of health issues men are reported to delay in seeking help from the conventional services. This is the case for men with HIV/AIDS [16,17], emotional problems [18,19], and chest pain [20]. Specific groups of men who are reluctant users of the health services such as homeless men [21,22] and young men [23][24][25][26] can also be identified.…”

Male frequent attenders of general practice and their help seeking preferences

“…The extended analysis reported in the current paper highlights both the diversity and complexity of men's help seeking behaviour, with the identification of a group of men whose help seeking behaviour runs contrary to traditional notions of masculinity [8,9]. Whilst some men within the study attempted to rationalise their frequent attendance of general practice by drawing on the traditional masculine traits of tolerance and delayed help seeking, others illustrated the presence of a very different masculinity, embracing professional help seeking and explicit in their intentions to visit the GP, should they experience any ill health.…”

“…There is a broad body of evidence to show that these stereotypical patterns of behaviour are based upon truths. Studies conducted in a variety of different populations of men, in varying states of health have found men to be hesitant in seeking health care [8,9]. There is also evidence showing lower levels of service use by men, compared to women [10,11].…”