“A Gay Man and a Doctor are Just like, a Recipe for Destruction”: How Racism and Homonegativity in Healthcare Settings Influence PrEP Uptake Among Young Black MSM

Abstract

Young, Black, gay bisexual or other MSM are significantly less likely to use PrEP than their White counterparts. These disparities may be due, in part, to medical mistrust and mistreatment within the healthcare system. This study aimed to uncover how young Black MSM's perceptions of, and experiences with, health care contribute to low engagement in the healthcare system and low PrEP utilization. In late 2017 and early 2018, we conducted six focus groups with 44 Black MSM ages 16-25 in Milwaukee. Focus group topics included participants' knowledge and perceptions of PrEP, perceptions and stereotypes about PrEP users, and general healthcare utilization patterns and behaviors. Focus group transcripts were transcribed verbatim and coded using MAXQDA qualitative analysis software. We used a team-based approach to thematic content analysis to understand how racism and homonegativity affected healthcare access and experiences. Results from this study help to characterize what contributes to mistrust of the healthcare system and healthcare providers to negatively affect PrEP use among young Black MSM. Focus group discussions revealed how previous and anticipated negative interactions with physicians and skepticism about the healthcare system have alienated young Black MSM from the health care system and created significant barriers to PrEP. Efforts to increase PrEP uptake and must address negative and discriminatory interactions with providers and the healthcare system.

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

“…Previous/anticipated negative interactions (perceived racism/homophobia) with physicians and skepticism about the healthcare system were reported to have alienated young Black MSM from the healthcare system and created barriers to PrEP use [189] Interview of Black MSM PrEP users (N = 26)…”

“…Greater medical mistrust was associated with lower willingness to take PrEP [181] cis cisgender, HIV human immunodeficiency virus, MSM men who have sex with men, PrEP pre-exposure prophylaxis, PWID people who inject drugs, TGW transgender women a Please see study of Black MSM in the ' 'Sexual orientation'' category, also applicable here [188] b Please see study of Black MSM aged 16-25 years in the ' 'Sexual orientation' ' category, also applicable here [189] c Please see study of Black MSM in the ' 'Sexual orientation' ' category, also applicable here [174] Cost/insurance concerns were reported as barriers in 36% of patients [161] Interviews with MSM at Rhode Island Department of Corrections (N = 26)…”

“… cis cisgender, HIV human immunodeficiency virus, MSM men who have sex with men, PrEP pre-exposure prophylaxis, PWID people who inject drugs, TGW transgender women a Please see study of Black MSM in the “Sexual orientation” category, also applicable here [ 188 ] b Please see study of Black MSM aged 16–25 years in the “Sexual orientation” category, also applicable here [ 189 ] c Please see study of Black MSM in the “Sexual orientation” category, also applicable here [ 174 ] …”

Ending HIV in America: Not Without the Power of Community

“…This suboptimal use speaks to the reality that many factors, beyond lack of awareness, can influence the uptake of PrEP by MSM who could benefit from its protective effects [45]. For example, several investigators have documented that medical mistrust and perceptions of racism and homonegativity in healthcare settings represent significant structural barriers to PrEP use among black MSM [46][47][48]. Add to this the fact that public trust in government among all racial and ethnic groups, including non-Hispanic whites, remains at historic lows [49] and one might reasonably predict that expanding physical access to PrEP, by itself, may not address all of the consequential factors impeding its use.…”

A conceptual model for pluralistic healthcare behavior: results from a qualitative study in southwestern Uganda

“…In contrast, patient-provider interactions in biomedical contexts included narratives of neglect and "abuse". The health effects of negative interactions with biomedical staff have been well described in cases of disengagement with HIV care among people living with HIV [33][34][35], decreased PrEP utilization among key populations [36] and among women giving birth [37][38][39]. Other researchers have similarly shown that traditional healers are favored in some cases because they provide social support within their communities, functioning as counselors, social workers, spiritual guides, and legal advisors [5,20,25,[40][41][42][43][44].…”