The role of patient–provider sexual health communication in understanding the uptake of HIV prevention services among Black men who have sex with men

Abstract

We examined factors that may be associated with whether Black men who have sex with men a) disclose their sexual orientation to healthcare providers, and b) discuss their sexual health with healthcare providers to inform interventions to improve HIV prevention efforts and reduce HIV incidence rates among Black men who have sex with men. During 2011-2012, we conducted semi-structured individual in-depth interviews with Black men who have sex with men in New York City. Interviews were audio recorded. We examined transcribed responses for main themes using a qualitative exploratory approach followed by computer-assisted thematic analyses. Twenty-nine men participated. The median age was 25.3 years; 41% (n = 12) earned an annual income of < US$10,000; 72% (n = 21) had a college degree; 86% (n = 25) reported being single; 69% (n = 20) self-identified as gay or homosexual. We identified three main themes affecting whether the men discussed their sexual orientation and sexual health with healthcare providers: 1) comfort discussing sexual health needs; 2) health literacy; and 3) trust. Identifying strategies for improved comfort, health literacy and trust between Black men who have sex with men and healthcare providers may be an important strategy for increasing sexual health patient-provider communications, increasing opportunities for HIV prevention including testing and reducing HIV-related health disparities.

Primary Care Providers’ Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions

“…It is also possible that they may also have been experiencing some of these barriers but felt more comfortable assigning them to others. Largely consistent with previous work, we found provider-identified barriers to providing to PrEP to include: discomfort discussing sexual behaviors and sexually transmitted infections with patients (Rucker et al, 2018;St. Vil et al, 2019), a lack of awareness or knowledge about PrEP (Pleuhs et al, 2020), a need for more training about how to provide PrEP services (Bleasdale et al, 2020;Clement et al, 2018), community-and provider-level homophobia and stigma towards people who are typically candidates for PrEP (Pleuhs et al, 2020), and patient barriers that might limit the ability to initiate or adhere to PrEP, such as low income, housing instability, and substance use (Pleuhs et al, 2020).…”

Sexual health literacy among gay, bisexual and other men who have sex with men: a conceptual framework for future research

“…Applying specifically to sexual health, it builds on Nutbeam's three-part model of functional, interactive and critical health literacy (Nutbeam 2000), and the broader definitions of health literacy that recognise dynamic and societal influences (Sørensen et al 2012;Nutbeam 2000;Rootman and Gordon-El-Bihbety 2008;Zarcadoolas, Pleasant, and Greer 2005;Nutbeam 2008). It extends the existing and limited field of sexual health literacy research (Freeman et al 2018;Vamos et al 2018;Lin, Zhang, and Cao 2018;Haruna et al 2019;Kaczkowski and Swartout 2019), particularly among gay, bisexual and other men who have sex with men (Rosenberger et al 2011;Eliason, Robinson, and Balsam 2018;Oliffe et al 2019;Manduley et al 2018;Gilbert et al 2019;Brookfield et al 2019;Rucker et al 2018), by advocating a multi-level approach to enable men to attain sexual health literacy in the context of social and cultural practices and forces that shape it. There is a challenge for communities to manage sexual health within the wider context of social stigma and shrinking healthcare services, while increasingly being asked to become (bio)medical experts in their own sexual healthcare.…”

“…Some studies have applied (existing and tailored) health literacy measures to our understanding of treatment adherence and health outcomes among people living with HIV (Perazzo, Reyes, and Webel 2017;Reynolds et al 2019). Much of this research has focused on young people and/or the individual-level (Haruna et al 2019;Freeman et al 2018;Vamos et al 2018;Lin, Zhang, and Cao 2018;Kaczkowski and Swartout 2019) and while a few studies have begun to examine health literacy inequities among gay, bisexual and other men who have sex with men (Rosenberger et al 2011;Manduley et al 2018;Gilbert et al 2019;Brookfield et al 2019;Rucker et al 2018;Eliason, Robinson, and Balsam 2018;Oliffe et al 2019), sexual health literacy as a concept remains under-developed.…”

Poor Self-efficacy for Healthcare Provider Interactions Among Individuals with HIV-Associated Neurocognitive Disorders

“…Additionally, the HAND+ group had nearly twice as many African Americans as the HAND − group, but the small cell sizes precluded any fine-grained examination of the role of ethnicity in self-efficacy for healthcare interactions. However, it may be particularly important to further explore this type of self-efficacy among African Americans, particularly in light of an emerging study demonstrating the importance of patient-provider communication (including factors such as comfort and trust) in the uptake of HIV prevention services ( (Rucker, Murray, Gaul, Sutton, & Wilson, 2017)). Our study did not have any measures of HIV stigma, but recent evidence suggest that the experience of HIV stigma, particularly in the healthcare setting, can negatively influence HIV treatment outcomes (Kay et al, 2017).…”