Health care access, health care utilisation and sexual orientation disclosure among Black sexual minority men in the Deep South
Ying He A , Derek T. Dangerfield II
B C J , Errol L. Fields D , Milton R. Dawkins F , Damon Johnson G , Dorothy C. Browne H I and DeMarc A. Hickson A C
+ Author Affiliations
- Author Affiliations
A My Brother’s Keeper, Inc., 407 Orchard Park, Ridgeland, MS 39157, USA.
B Johns Hopkins School of Nursing, 525 N Wolfe Street, Baltimore, MD 21205, USA.
C Us Helping Us, People Into Living, Inc., 3636 Georgia Avenue NW, Washington, DC 20010, USA.
D Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N Wolfe Street, Baltimore, MD 21287, USA.
E Department of Psychology, Jackson State University, Jackson, MS 39213, USA.
F School of Public Health, University of Maryland, 4200 Valley Drive #2242, College Park, MD 20742, USA.
G USA National AIDS and Education Services for Minorities, Inc., 2140 Martin Luther King Jr Drive SW, Atlanta, GA 30310, USA.
H Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
I University of Duy Tan, 254 Nguyen Van Linh, Thanh Khe District, Da Nang, Vietnam.
J Corresponding author. Email: ddanger2@jhu.edu
Sexual Health 17(5) 421-428 https://doi.org/10.1071/SH20051
Submitted: 31 March 2020 Accepted: 1 September 2020 Published: 12 November 2020
Journal Compilation © CSIRO 2020 Open Access CC BY-NC-ND
Abstract
Background: Black gay, bisexual, and other sexual minority men (BSMM) account for 39.1% of new HIV infections among men who have sex with men and 78.9% of newly diagnosed cases among Black men. Health care access, health care utilisation and disclosing sexuality to providers are important factors in HIV prevention and treatment. This study explored the associations among sexual orientation disclosure, health care access and health care utilisation among BSMM in the Deep South. Methods:Secondary analysis of existing data of a population-based study in Jackson, Mississippi, and Atlanta, Georgia, was conducted among 386 BSMM. Poisson regression models were used to estimate prevalence ratios (PR) between sexual orientation disclosure to healthcare providers, health care access and health care utilisation. Results:The mean (±s.d.) age of participants was 30.5 ± 11.2 years; 35.3% were previously diagnosed with HIV and 3.7% were newly diagnosed with HIV. Two-thirds (67.2%) self-identified as homosexual or gay; 70.6% reported being very open about their sexual orientation with their healthcare providers. After adjustment, BSMM who were not open about their sexual orientation had a lower prevalence of visiting a healthcare provider in the previous 12 months than those who were very open with their healthcare provider (PR 0.42; 95% confidence interval 0.18–0.97). Conclusion:Clinics, hospitals and other healthcare settings should promote affirming environments that support sexuality disclosure for BSMM.
Keywords: HIV, sexual health, sexually transmissible infection (STI), stigma.
References
[1] Dangerfield DT, Harawa NT, McWells C, Hilliard C, Bluthenthal RN. Exploring the preferences of a culturally congruent, peer-based HIV prevention intervention for black men who have sex with men. Sex Health 2018; 15 424–30.| Exploring the preferences of a culturally congruent, peer-based HIV prevention intervention for black men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[2] Young RM, Meyer IH. The trouble with ‘MSM’ and ‘WSW’: erasure of the sexual-minority person in public health discourse. Am J Public Health 2005; 95 1144–9.
| The trouble with ‘MSM’ and ‘WSW’: erasure of the sexual-minority person in public health discourse.Crossref | GoogleScholarGoogle Scholar | 15961753PubMed |
[3] Rao S, Song W, Mulatu MS, Rorie M, O’Connor K, Scales L. HIV partner service delivery among Blacks or African Americans – United States, 2016. MMWR Morb Mortal Wkly Rep 2019; 68 81–6.
| HIV partner service delivery among Blacks or African Americans – United States, 2016.Crossref | GoogleScholarGoogle Scholar | 30703079PubMed |
[4] Hess KL, Hu X, Lansky A, Mermin J, Hall HI. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol 2017; 27 238–43.
| Lifetime risk of a diagnosis of HIV infection in the United States.Crossref | GoogleScholarGoogle Scholar | 28325538PubMed |
[5] Reif S, Safley D, McAllaster C, Wilson E, Whetten K. State of HIV in the US Deep South. J Community Health 2017; 42 844–53.
| State of HIV in the US Deep South.Crossref | GoogleScholarGoogle Scholar | 28247067PubMed |
[6] Watson M, Johnson SD, Zhang T, Oster AM. Characteristics of and trends in HIV diagnoses in the Deep South region of the United States, 2012–2017. AIDS Behav 2019; 23 224–32.
| Characteristics of and trends in HIV diagnoses in the Deep South region of the United States, 2012–2017.Crossref | GoogleScholarGoogle Scholar | 31473847PubMed |
[7] Centers for Disease Control and Prevention. HIV surveillance report, vol. 28: diagnoses of HIV infection in the United States and dependent areas, 2016. 2017. Available online at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2016-vol-28.pdf [verified 20 May 2020].
[8] Centers for Disease Control and Prevention. Sexually transmitted diseases surveillance 2017: gonorrhea. 2018. Available online at: https://www.cdc.gov/std/stats17/gonorrhea.htm [verified 16 October 2018].
[9] Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2016. 2017. Available online at: https://www.cdc.gov/std/stats16/CDC_2016_STDS_Report-for508WebSep21_2017_1644.pdf [verified 5 October 2017].
[10] Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care 2017; 29 1351–8.
| Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts.Crossref | GoogleScholarGoogle Scholar | 28286983PubMed |
[11] Quinn K, Dickson-Gomez J, Zarwell M, Pearson B, Lewis M. ‘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 2019; 23 1951–63.
| ‘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.Crossref | GoogleScholarGoogle Scholar | 30565092PubMed |
[12] Yang C, Krishnan N, Painter JE, Latkin C. The association between disclosure of same sex behavior to healthcare providers and PrEP awareness among BMSM in Baltimore. AIDS Behav 2019; 23 1888–92.
| The association between disclosure of same sex behavior to healthcare providers and PrEP awareness among BMSM in Baltimore.Crossref | GoogleScholarGoogle Scholar | 30666521PubMed |
[13] Gulliford M, Figueroa-Munoz J, Morgan M, Hughes D, Gibson B, Beech R, et al What does ‘access to health care’ mean? J Health Serv Res Policy 2002; 7 186–8.
| 12171751PubMed |
[14] Heidari O, Dangerfield DT, Hickson DA. Sexual risk and sexual healthcare utilization profiles among Black sexual minority men in the U.S. Deep South. AIDS Care 2020; 32 1602–9.
| Sexual risk and sexual healthcare utilization profiles among Black sexual minority men in the U.S. Deep South.Crossref | GoogleScholarGoogle Scholar | 32476446PubMed |
[15] Arnold EA, Rebchook GM, Kegeles SM. ‘Triply cursed’: racism, homophobia, and HIV-related stigma are barriers to regular HIV testing, treatment adherence, and disclosure among young Black gay men. Cult Health Sex 2014; 16 710–22.
| ‘Triply cursed’: racism, homophobia, and HIV-related stigma are barriers to regular HIV testing, treatment adherence, and disclosure among young Black gay men.Crossref | GoogleScholarGoogle Scholar | 24784224PubMed |
[16] Quinn K, Bowleg L, Dickson-Gomez J. ‘The fear of being Black plus the fear of being gay’: the effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med 2019; 232 86–93.
| ‘The fear of being Black plus the fear of being gay’: the effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 31075752PubMed |
[17] Dale SK, Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Medical mistrust is related to lower longitudinal medication adherence among African–American males with HIV. J Health Psychol 2016; 21 1311–21.
| Medical mistrust is related to lower longitudinal medication adherence among African–American males with HIV.Crossref | GoogleScholarGoogle Scholar | 25293970PubMed |
[18] Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, et al The role of stigma and medical mistrust in the routine health care engagement of Black men who have sex with men. Am J Public Health 2015; 105 e75–82.
| The role of stigma and medical mistrust in the routine health care engagement of Black men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 25521875PubMed |
[19] McKirnan DJ, Du Bois SN, Alvy LM, Jones K. Health care access and health behaviors among men who have sex with men: the cost of health disparities. Health Educ Behav 2013; 40 32–41.
| Health care access and health behaviors among men who have sex with men: the cost of health disparities.Crossref | GoogleScholarGoogle Scholar | 22505573PubMed |
[20] Bernstein KT, Liu K-L, Begier EM, Koblin B, Karpati A, Murrill C. Same-sex attraction disclosure to health care providers among New York City men who have sex with men: implications for HIV testing approaches. Arch Intern Med 2008; 168 1458–64.
| Same-sex attraction disclosure to health care providers among New York City men who have sex with men: implications for HIV testing approaches.Crossref | GoogleScholarGoogle Scholar | 18625927PubMed |
[21] Wolitski RJ, Jones KT, Wasserman JL, Smith JC. Self-identification as ‘down low’ among men who have sex with men (MSM) from 12 US cities. AIDS Behav 2006; 10 519–29.
| Self-identification as ‘down low’ among men who have sex with men (MSM) from 12 US cities.Crossref | GoogleScholarGoogle Scholar | 16691462PubMed |
[22] Malebranche DJ, Peterson JL, Fullilove RE, Stackhouse RW. Race and sexual identity: perceptions about medical culture and healthcare among Black men who have sex with men. J Natl Med Assoc 2004; 96 97–107.
| 14746359PubMed |
[23] Ng BE, Moore D, Michelow W, Hogg R, Gustafson R, Robert W, et al Relationship between disclosure of same-sex sexual activity to providers, HIV diagnosis and sexual health services for men who have sex with men in Vancouver, Canada. Can J Public Health 2014; 105 e186–91.
| Relationship between disclosure of same-sex sexual activity to providers, HIV diagnosis and sexual health services for men who have sex with men in Vancouver, Canada.Crossref | GoogleScholarGoogle Scholar | 25165837PubMed |
[24] Watson RJ, Fish JN, Allen A, Eaton L. Sexual identity disclosure and awareness of HIV prevention methods among Black men who have sex with men. J Sex Res 2018; 55 975–83.
| Sexual identity disclosure and awareness of HIV prevention methods among Black men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 29023141PubMed |
[25] Hickson DA, Truong NL, Smith-Bankhead N, Sturdevant N, Duncan DT, Schnorr J, et al Rationale, design and methods of the Ecological Study of Sexual Behaviors and HIV/STI among African American Men Who Have Sex with Men in the Southeastern United States (the MARI Study). PLoS One 2015; 10 e0143823
| Rationale, design and methods of the Ecological Study of Sexual Behaviors and HIV/STI among African American Men Who Have Sex with Men in the Southeastern United States (the MARI Study).Crossref | GoogleScholarGoogle Scholar | 26700018PubMed |
[26] Dangerfield DT, Johnson D, Hamlin-Palmer S, Browne DC, Mayer KH, Hickson DA. Prevalence and correlates of rectal douching and enema use among Black sexual minority men and Black transwomen in the Deep South. Arch Sex Behav 2020; 49 1915–22.
| 32086643PubMed |
[27] Wylie SA, Corliss HL, Boulanger V, Prokop LA, Austin SB. Socially assigned gender nonconformity: a brief measure for use in surveillance and investigation of health disparities. Sex Roles 2010; 63 264–76.
| Socially assigned gender nonconformity: a brief measure for use in surveillance and investigation of health disparities.Crossref | GoogleScholarGoogle Scholar | 24077680PubMed |
[28] Baggaley RF, Owen BN, Silhol R, Anton P, McGowan I, van der Straten A, et al. Per act HIV transmission risk through anal intercourse: an updated systematic review and meta-analysis. In: HIV Research for Prevention Conference; 21–25 October 2018; Madrid, Spain. 2018. Available online at: http://www.natap.org/2018/HIVR4P/BaggaleyEtAlPosterR4P_2018.pdf [verified 21 November 2018].
[29] Dangerfield DT, Smith LR, Williams J, Unger J, Bluthenthal R. Sexual positioning among men who have sex with men: a narrative review. Arch Sex Behav 2017; 46 869–84.
| Sexual positioning among men who have sex with men: a narrative review.Crossref | GoogleScholarGoogle Scholar | 27178171PubMed |
[30] Amirkhanian YA. Social networks, sexual networks and HIV risk in men who have sex with men. Curr HIV/AIDS Rep 2014; 11 81–92.
| Social networks, sexual networks and HIV risk in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 24384832PubMed |
[31] Tieu H-V, Liu T-Y, Hussen S, Connor M, Wang L, Buchbinder S, et al Sexual networks and HIV risk among Black men who have sex with men in 6 U.S. cities. PLoS One 2015; 10 e0134085
| Sexual networks and HIV risk among Black men who have sex with men in 6 U.S. cities.Crossref | GoogleScholarGoogle Scholar | 26241742PubMed |
[32] Centers for Disease Control and Prevention. HIV and African American gay and bisexual men. 2017. Available online at: https://www.cdc.gov/hiv/group/msm/bmsm.html [verified 7 December 2017].
[33] Centers for Disease Control and Prevention. Taking a sexual history. 2020. Available online at: https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/sexual-history.html [verified 16 October 2020].
[34] Hui B, Fairley CK, Chen M, Grulich A, Hocking J, Prestage G, et al Oral and anal sex are key to sustaining gonorrhoea at endemic levels in MSM populations: a mathematical model. Sex Transm Infect 2015; 91 365–9.
| Oral and anal sex are key to sustaining gonorrhoea at endemic levels in MSM populations: a mathematical model.Crossref | GoogleScholarGoogle Scholar | 25596192PubMed |
[35] Bernstein KT, Marcus JL, Nieri G, Philip SS, Klausner JD. Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion J Acquir Immune Defic Syndr 2010; 53 537–43.
| Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversionCrossref | GoogleScholarGoogle Scholar | 19935075PubMed |
[36] Johns MM, Pingel E, Eisenberg A, Santana ML, Bauermeister J. Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. Am J Mens Health 2012; 6 505–18.
| Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men.Crossref | GoogleScholarGoogle Scholar | 22843811PubMed |
[37] Hoppe T. Circuits of power, circuits of pleasure: sexual scripting in gay men’s bottom narratives. Sexualities 2011; 14 193–217.
| Circuits of power, circuits of pleasure: sexual scripting in gay men’s bottom narratives.Crossref | GoogleScholarGoogle Scholar |
[38] Dangerfield DT, Ober AJ, Smith LR, Shoptaw S, Bluthenthal RN. Exploring and adapting a conceptual model of sexual positioning practices and sexual risk among HIV-negative Black men who have sex with men. J Sex Res 2018; 55 1022–32.
| Exploring and adapting a conceptual model of sexual positioning practices and sexual risk among HIV-negative Black men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 29466064PubMed |
[39] Fields EL, Bogart LM, Smith KC, Malebranche DJ, Ellen J, Schuster MA. HIV risk and perceptions of masculinity among young Black men who have sex with men. J Adolesc Health 2012; 50 296–303.
| HIV risk and perceptions of masculinity among young Black men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 22325136PubMed |
[40] Geter A, Crosby RA, Mena L. Young Black men who have sex with men and women: to disclose or not to disclose, what’s the risk in the South? J Black Sex Relatsh 2016; 2 57–66.
| Young Black men who have sex with men and women: to disclose or not to disclose, what’s the risk in the South?Crossref | GoogleScholarGoogle Scholar |
[41] Durso LE, Meyer IH. Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sex Res Social Policy 2013; 10 35–42.
| Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals.Crossref | GoogleScholarGoogle Scholar | 23463442PubMed |
[42] Petroll AE, Mosack KE. Physician awareness of sexual orientation and preventive health recommendations to men who have sex with men. Sex Transm Dis 2011; 38 63–7.
| Physician awareness of sexual orientation and preventive health recommendations to men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 20706178PubMed |
