“A gay man and a doctor are jt like, a recipe for stctn”: How racism and homonegativy healthre settgs fluence PrEP uptake among young Black MSM - PMC

Contents:

• “A GAY MAN AND A DOCTOR ARE JT LIKE, A RECIPE FOR STCTN”: HOW RACISM AND HOMONEGATIVY HEALTHRE SETTGS FLUENCE PREP UPTAKE AMONG YOUNG BLACK MSM
• GAY AND BISEXUAL MEN'S HEALTH ISSU
• NEW REARCH CHAIR GAY MEN’S HEALTH IS SETTG OUT TO BREAK DOWN BARRIERS TO RE
• SUBSTANCE USE PATTERNS OF GAY AND BISEXUAL MEN THE MOMENTUM HEALTH STUDY
• GAY, BISEXUAL MEN UTAH N GIVE BLOOD UNR PANY’S LOOSENED RTRICTNS

“A GAY MAN AND A DOCTOR ARE JT LIKE, A RECIPE FOR STCTN”: HOW RACISM AND HOMONEGATIVY HEALTHRE SETTGS FLUENCE PREP UPTAKE AMONG YOUNG BLACK MSM

Published fal eded form as:PMCID: PMC6571052NIHMSID: NIHMS1516922AbstractYoung, Black, gay bisexual or other MSM are signifintly ls likely to e PrEP than their Whe unterparts.

We ed a team-based approach to thematic ntent analysis to unrstand how racism and homonegativy affected healthre accs and experienc. Keywords: Medil mistst, racial dispari, PrEP dispari, young adults, qualative, racism, homonegativyHIV pre-exposure prophylaxis (PrEP) is a promisg ponent of HIV preventn, particularly for gay, bisexual, and other men who have sex wh men (MSM), monstratg high efficy among adherent ers1, 2. Incln creria required that participants intify as Black or Ain Amerin, were assigned male genr at birth, intified as gay, bisexual, or other men who have sex wh men, were between the ag of 16 and 25, and reported an HIV-negative or unknown serostat.

GAY AND BISEXUAL MEN'S HEALTH ISSU

We explicly asked about experienc of discrimatn, racism, and homonegativy om health re provirs and sought to unrstand how the factors may affect PrEP uptake among young Black analysisFoc groups were d-rerd, transcribed verbatim, and d g MAXQDA qualative analysis software.

The fal book clud barriers to PrEP (cludg stigma, lack of support, and perceptn of need), benefs of PrEP, medil mistst, discrimatn healthre settgs, PrEP stigma, homonegativy (cludg ‘down low’, homonegativy wh the Black muny, ternalized homonegativy, and anticipated homonegativy), and racism (cludg differenc healthre treatment by race and racial discrimatn). Seventy-five percent (n=33) intified as gay; others intified as bisexual (n=8), pansexual (n=1), no label (n=1), and straight (n=1).

Analys revealed the ntued effects of racial and enomic disadvantage on health re accs and the ways which racism and homonegativy fluenced young men’s fort discsg sexual behavr wh physicians. [Foc group six]Although this excerpt they were discsg healthre more generally, the perceptn of receivg ferr medil treatment n ntribute to dividuals’ reluctance to start discsg perceived substandard re for Black gay men, foc group three participants scribed how racism, homonegativy, discrimatn, and poor medil re had bee expected and accepted as part of their health re. Precedg the followg excerpt om foc group three, several participants had jt shared personal stori of discrimatn and poor treatment:Facilator: Why do we, as a gay Black muny, why do we allow suatns like that to bee a mon thg?

NEW REARCH CHAIR GAY MEN’S HEALTH IS SETTG OUT TO BREAK DOWN BARRIERS TO RE

Through their own experienc and those of their fay, iends, and muny members, participants uld rell so many experienc of stigma and mistreatment that they had e to expect and accept homonegativy, racism, and discrimatn. This is not to say they did not intify the jtice this or sire better re, but such experienc had bee so monplace that they were no longer shockg or Black MSM rced to their sexualy by doctorsThe perceived racism participants faced was plited by the tersectn of homonegativy. While the lack of a tsted, regular provir was one factor this, this disfort was also rooted anticipated homonegativy and poor treatment om physicians.

P1: I don’t want to say ’s all Whe doctors, ‘e I’ve had some good on, but ’s jt that they treat gay men like we nasty… I even asked, “If you don’t wanna do , you n brg a woman nurse here if you want to. The fear of both race- and sexualy-based discrimatn and prejudice om Whe physicians ntributed to the notn that a gay man and doctor is a “recipe for stctn.

SUBSTANCE USE PATTERNS OF GAY AND BISEXUAL MEN THE MOMENTUM HEALTH STUDY

Mistst of physician motiv for wantg to know about sexual behavrs often stemmed om past experienc of discrimatn and homonegativy. He jt assumed bee I was Black and I was gay, that this is what happened… I really, to be hont, I don’t know I’ve been to the doctor sce then.

Participants noted that, upon revealg sexual behavrs, physicians only looked at them as young gay men at risk for HIV, rather than treatg them as a whole person, wh other healthre needs. Among those who felt PrEP was beg phed on the Black gay muny, there was skepticism about the effectivens and tentns of PrEP. Specifilly, several men raised ncerns about the ‘ttg’ of meditns on Black and gay people and exprsed skepticism about the targetg of PrEP toward Black MSM.

This skepticism about physician tentns was amplified for the young men who were ntendg wh racism and homonegativy healthre settgs, which rerced medil mistst. The majory, however, did not have an tablished provir and reported more disfort wh and greater perceived homonegativy om physicians.

GAY, BISEXUAL MEN UTAH N GIVE BLOOD UNR PANY’S LOOSENED RTRICTNS

Seeg a new physician at every vis meant that, if they were to disclose their sexual orientatn, they would be ‘g out’ over and over aga and face the strs and risks associated wh disclosure at every vis, as they anticipated homonegativy and mistreatment. Although genr was not as notable a factor as race, there were several participants who exprsed preference for female provirs, whom they perceived to be more motherly and ls homophobic.

Participants believed physician-iated nversatns about PrEP revealed physicians’ stereotyp about gay men, particularly Black gay men, as ‘risky’. Racism and homonegativy have alienated young Black MSM om the health re system and created signifint systematic barriers to health re and has been documented prev rearch35, 36, generatns of medil mistreatment and historil disadvantage have ntributed to stctural and cultural barriers that ma difficult for the young men to tablish re wh a tsted physician.