"Let's Be a Person to Person and Have a Genuine Conversation": Comparing Perspectives on PrEP and Sexual Health Communication Between Black Sexual Minority Men and Healthcare Providers

Sarah K. Calabrese, Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA. skcalabrese@gwu.edu.
Sharanya Rao, Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
Adam I. Eldahan, Columbia School of Nursing, Columbia University, New York, NY, USA.
Mehrit Tekeste, Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
Djordje Modrakovic, Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
D Dangaran, Harvard Law School, Harvard University, Cambridge, MA, USA.
Cheriko A. Boone, Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
Kristen Underhill, Columbia Law School, Columbia University, New York, NY, USA.
Douglas S. Krakower, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA.
Kenneth H. Mayer, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA.
Nathan B. Hansen, Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA.
Trace S. Kershaw, Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA.
Manya Magnus, Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA.
Joseph R. Betancourt, Disparities Solution Center, Harvard University, Boston, MA, USA.
John F. Dovidio, Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA.

Document Type

Journal Article

Publication Date

7-1-2022

Journal

Archives of sexual behavior

Volume

51

Issue

5

DOI

10.1007/s10508-021-02213-3

Keywords

Black sexual minority men; Healthcare providers; PrEP; Sexual health; Sexual orientation

Abstract

Patient-provider communication is a key factor affecting HIV pre-exposure prophylaxis (PrEP) awareness and access among Black sexual minority men (SMM). Optimizing patient-provider communication requires a deeper understanding of communication dynamics. In this study, we investigated the perspectives of both HIV-negative/status-unknown Black SMM and practicing community healthcare providers regarding patient-provider communication about PrEP and sexual health. We conducted eleven semi-structured qualitative focus groups (six with Black SMM; five with providers) in the Northeastern USA and thematically analyzed transcripts. A total of 36 Black SMM and 27 providers participated in the focus groups. Our analysis revealed points of alignment and divergence in the two groups' perspectives related to patient-provider communication. Points of alignment included: (1) the importance ascribed to maximizing patients' comfort and (2) belief in patients' right to non-discriminatory healthcare. Points of divergence included: (1) Black SMM's preference for sexual privacy versus providers' preference that patients share sexual information, (2) Black SMM's perception that providers have an ethical responsibility to initiate conversations about PrEP with patients versus providers' perception of such conversations as being optional, and (3) Black SMM's preference for personalized sexual health conversations versus providers' preference for standardized conversations. Findings underscore a need for providers to offer more patient-centered sexual healthcare to Black SMM, which should entail routinely presenting all prevention options available-including PrEP-and inviting open dialogue about sex, while also respecting patients' preferences for privacy about their sexuality. This approach could increase PrEP access and improve equity in the US healthcare system.

Department

Epidemiology

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