The Socioecology of Sexual and Reproductive Health Care Use Among Young Urban Minority Males

Abstract

Purpose To explore perceptions of facilitators/barriers to sexual and reproductive health (SRH) care use among an urban sample of African American and Hispanic young men aged 15–24, including sexual minorities. Methods Focus groups were conducted between April 2013 and May 2014 in one mid-Atlantic U.S. city. Young men aged 15–24 were recruited from 8 community settings to participate in 12 groups. Moderator guide explored facilitators/barriers to SRH care use. A brief pre-group self-administered survey assessed participants’ sociodemographics and SRH information sources. Content analysis was conducted and three investigators independently verified the themes that emerged. Results Participants included 70 males: 70% were aged 15–19, 66% African American, 34% Hispanic, 83% heterosexual and 16% gay/bisexual. Results indicated young men’s perceptions of facilitators/barriers to their SRH care use come from multiple levels of their socio-ecology, including cultural, structural, social and personal contexts, and dynamic interrelationships existed across contexts. A healthcare culture focused on women’s health and traditional masculinity scripts provided an overall background. Structural level concerns included cost, long visits, and confidentiality; social level concerns included stigma of being seen by community members and needs regarding healthcare provider interactions; and personal level concerns included self-risk assessments on decisions to seek care and fears/anxieties about STI/HIV testing. Young men also discussed SRH care help-seeking sometimes involved family and/or other social network members and needs related to patient-provider interactions about SRH care. Conclusions Study findings provide a foundation for better understanding young men’s SRH care use and considering ways to engage them in care.

<p>Perspectives on Adolescent Pregnancy Prevention Strategies in the United States: Looking Back, Looking Forward</p>

“…19,42 Males in particular often feel unwelcome in clinic settings. 43 Clinics and programs need to address and respond to the barriers that adolescents face when seeking sexual health services. Some clinics have implemented special community outreach and education strategies to help young people access care.…”

“The right place and the right time”: A qualitative study of the decision‐making process of self‐initiated HIV testing among young adults

“…However, this basis for testing does not effectively reach young adults who are vulnerable to HIV infection, thereby not meeting their testing needs (Adebayo & Gonzalez‐Guarda, 2017; Van Handel et al, 2016). Young adults experience barriers like an inability to afford healthcare visits, fear of judgement, discrimination, and stigma that impede clinician‐initiated testing (Center for Disease Control and Prevention CDC, 2019a; Marcell et al, 2017; Pharr, Lough, & Ezeanuolue, 2015). Furthermore, clinicians and young adults experience difficulties engaging in conversations about sexual orientation and sexual risk behaviors, which limit adequate assessment for HIV testing recommendations (Eisenberg, Lust, Mathiason, & Porta, 2017; Leonard et al, 2010; Marcell et al, 2017; Pharr et al, 2015).…”

“…Young adults experience barriers like an inability to afford healthcare visits, fear of judgement, discrimination, and stigma that impede clinician‐initiated testing (Center for Disease Control and Prevention CDC, 2019a; Marcell et al, 2017; Pharr, Lough, & Ezeanuolue, 2015). Furthermore, clinicians and young adults experience difficulties engaging in conversations about sexual orientation and sexual risk behaviors, which limit adequate assessment for HIV testing recommendations (Eisenberg, Lust, Mathiason, & Porta, 2017; Leonard et al, 2010; Marcell et al, 2017; Pharr et al, 2015). The limitations of clinician‐initiated testing have led to missed opportunities for HIV testing among young adults (Lazar, Salas‐Humara, Wood, Mollen, & Dowshen, 2018; Leonard et al, 2010).…”

“…and young adults experience difficulties engaging in conversations about sexual orientation and sexual risk behaviors, which limit adequate assessment for HIV testing recommendations (Eisenberg, Lust, Mathiason, & Porta, 2017;Leonard et al, 2010;Marcell et al, 2017;Pharr et al, 2015). The limitations of clinician-initiated testing have led to missed opportunities for HIV testing among young adults (Lazar, Salas-Humara, Wood, Mollen, & Dowshen, 2018;Leonard et al, 2010).…”

The Visible Man: Gendering Health Care Services to Improve Young Men's Sexual Health

“…The intervention had five components: (1) outreach to men to encourage seeking of sexual health services; (2) community engagement to increase awareness of the availability of men's services; (3) improved clinic efficiency to reduce wait times; (4) gender sensitivity training to enhance staff awareness about distinctive qualities of men's sexual health care needs; and (5) adaptation of forms, policies, protocols, and educational material to reflect men's issues. These five components reflect documented barriers to men's sexual health care seeking: conflict of traditional masculinity with a feminized health care culture; concerns over wait times and cost; and perceived lack of community support for sexual health care seeking [5,6]. The intervention was tested with a preintervention/postintervention comparison design, comparing two family planning clinics to five nonintervention clinics with similar patient demographics and services.…”