"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; Sharanya Rao; Adam I Eldahan; Mehrit Tekeste; Djordje Modrakovic; D Dangaran; Cheriko A Boone; Kristen Underhill; Douglas S Krakower; Kenneth H Mayer; Nathan B Hansen; Trace S Kershaw; Manya Magnus; Joseph R Betancourt; John F Dovidio

doi:10.1007/s10508-021-02213-3

"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

Arch Sex Behav. 2022 Jul;51(5):2583-2601. doi: 10.1007/s10508-021-02213-3. Epub 2022 Jul 5.

Authors

Sarah K Calabrese^#^{1

2}, Sharanya Rao^#³, Adam I Eldahan⁴, Mehrit Tekeste³, Djordje Modrakovic³, D Dangaran⁵, Cheriko A Boone³, Kristen Underhill^{6

7}, Douglas S Krakower^{8

9

10}, Kenneth H Mayer^{8

9

11}, Nathan B Hansen¹², Trace S Kershaw¹³, Manya Magnus¹⁴, Joseph R Betancourt¹⁵, John F Dovidio^{13

16}

Affiliations

¹ Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA. skcalabrese@gwu.edu.
² Department of Prevention and Community Health, George Washington University, Washington, DC, USA. skcalabrese@gwu.edu.
³ Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
⁴ Columbia School of Nursing, Columbia University, New York, NY, USA.
⁵ Harvard Law School, Harvard University, Cambridge, MA, USA.
⁶ Columbia Law School, Columbia University, New York, NY, USA.
⁷ Heilbrunn Department of Population and Family Health, Columbia University, New York, NY, USA.
⁸ Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA.
⁹ The Fenway Institute, Fenway Health, Boston, MA, USA.
¹⁰ Department of Population Medicine, Harvard University, Boston, MA, USA.
¹¹ Department of Global Health and Population, Harvard University, Boston, MA, USA.
¹² Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA.
¹³ Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA.
¹⁴ Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA.
¹⁵ Disparities Solution Center, Harvard University, Boston, MA, USA.
¹⁶ Department of Psychology, Yale University, New Haven, CT, USA.

^# Contributed equally.

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.

Keywords: Black sexual minority men; Healthcare providers; PrEP; Sexual health; Sexual orientation.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

HIV Infections* / prevention & control
Health Communication*
Health Personnel
Homosexuality, Male
Humans
Male
Sexual Health*
Sexual and Gender Minorities*

Abstract

Publication types

MeSH terms

Grants and funding