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“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

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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.

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Acknowledgements

We are incredibly grateful to the young people who participated in this study and we were willing to share intimate details about their lives and healthcare experiences. This research would not have been possible without the community organizations and leaders who partner with us.

Funding

This study was funded by the National Institute of Mental Health (K01 MH112412; PI: Quinn) and supported by the National Institute of Mental Health Center Grant (P30-MH52776; PI: J. Kelly).

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research Medical College of Wisconsin, Milwaukee, WI, USA

    Katherine Quinn, Julia Dickson-Gomez, Meagan Zarwell & Broderick Pearson

  2. Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA

    Julia Dickson-Gomez

  3. Diverse and Resilient, Milwaukee, WI, USA

    Matthew Lewis

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  1. Katherine Quinn
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  2. Julia Dickson-Gomez
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Correspondence to Katherine Quinn.

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All study procedures were in accordance with the ethical standards of the Institutional Review Board at the Medical College of Wisconsin and with the 1964 Helsinki declaration and its later amendments.

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Quinn, K., Dickson-Gomez, J., Zarwell, M. et al. “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. AIDS Behav 23, 1951–1963 (2019). https://doi.org/10.1007/s10461-018-2375-z

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