Health Care Access and Health Behaviors Among Men Who Have Sex With Men

Abstract

Men who have sex with men (MSM) appear to experience barriers to health care compared with general population men. This report examines individual differences in health care access within a diverse sample of urban MSM (N = 871). The authors examined demographic differences in health care access and the relation between access and health-related attitudes, health behaviors, and HIV transmission risk. They operationalized health care access in terms of three indicators: perceived barriers, insurance status, and recent medical visit. Twenty-seven percent (n = 227) of MSM reported zero or one health care access indicator. African American and Latino race/ethnicity, lower income, and HIV-unknown status were associated with limited health care access. Limited health care access was related to health care attitudes (mistrust in the health care system and difficulty disclosing MSM status to providers), general health behaviors (smoking, never being HIV-tested, and drug abuse), and sexual risk-related variables (low self-efficacy for sexual safety, consistent drug use during sex, and HIV transmission risk). Overall, among MSM, less health care access relates to several adverse psychological constructs and health behaviors. Researchers and public health officials should address limited health care access, and its consequences, in this population.

Participant Experiences and Facilitators and Barriers to Pill Use Among Men Who Have Sex with Men in the iPrEx Pre-Exposure Prophylaxis Trial in San Francisco

“…30,31 Previous studies have shown that healthy MSM access healthcare less than the general male population. 32,33 Our study suggests that accessing PrEP may be a gateway for MSM to engage in regular HIV/STI testing, health monitoring, and other preventive services. The client-centered care that participants received also encouraged honest reporting of missed pills at the SF site.…”

A Qualitative Study of Medical Mistrust, Perceived Discrimination, and Risk Behavior Disclosure to Clinicians by U.S. Male Sex Workers and Other Men Who Have Sex with Men: Implications for Biomedical HIV Prevention

“…Prior studies have found that mistrust, disclosure difficulties, and internalized homophobia may limit healthcare access and delay presentation for care among MSM. [11][12][13][14] A recent study of New York MSM found that although most had seen a clinical provider recently, 39 % did not disclose sexual activity with male partners, with lower rates among African American and Latino MSM. 15 Medical mistrust, [16][17][18][19] discrimination experiences, [18][19][20][21] conspiracy beliefs, 19,22,23 and concerns about disclosure may be particularly significant barriers to PrEP access among MSM of color, as demonstrated by a recent PrEP acceptability study among African American MSM.…”

Reframing and Understanding the HIV Epidemic in MSM: Masculinity, Racism, and Homophobia

“…Mistrust is associated with avoidance of HIV testing and poor treatment adherence (Hill & McNeely, 2013;Millett et al, 2012). McKrinan et al (2012) suggested that ''men who experience stigma or barriers within health care settings may avoid personal disclosure, whereas men who are loathe to disclose their sexual orientation may avoid health care settings' ' (p. 38).…”

“…Homophobic sentiment is embedded in laws and social policies in the United States, subsequently undermining the health of MSM. MSM lack same-sex marriage rights or domestic partner benefits in many states, which limits their access to health care and insurance (McKrinan, Du Bois, Alvy, & Jones, 2012). In states where same-sex marriage is not legal, there are insurmountable financial barriers to preexposure prophylaxis and antiretroviral therapy (ART) if one partner has HIV (Human Rights Campaign, 2014).…”