title: 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.
abstract: Gay and bisexual men and other men who have sex with men (MSM) account for more than two thirds of new HIV infections in the U.S., with Black MSM experiencing the greatest burden. Antiretroviral pre-exposure prophylaxis (PrEP) can reduce MSM's vulnerability to HIV infection. Uptake of PrEP has been limited, particularly among racial and ethnic minority MSM. Four semi-structured focus groups with gay and bisexual men and other MSM at risk for HIV infection were convened in Boston and Jackson in late 2013. The analysis plan utilized a within-case, across-case approach to code and analyze emerging themes, and to compare results across the two cities. Participants recruited in Jackson were primarily Black gay men, while Boston participants were mostly non-Hispanic White gay men. Participants in both sites shared concerns about medication side effects and culturally insensitive health care for gay men. Jackson participants described stronger medical mistrust, and more frequently described experiences of anti-gay and HIV related stigma. Multiple addressable barriers to PrEP uptake were described. Information about side effects should be explicitly addressed in PrEP education campaigns. Providers and health departments should address medical mistrust, especially among Black gay and bisexual men and other MSM, in part by training providers in how to provide affirming, culturally competent care. Medicaid should be expanded in Mississippi to cover low-income young Black gay and bisexual men and other MSM.
authors.affiliation: a The Fenway Institute, Fenway Health , Boston , USA.|b School of Public Policy and Urban Affairs , Northeastern University , Boston , USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Cahill
authors.affiliation: a The Fenway Institute, Fenway Health , Boston , USA.|c Wheelock College , Boston , USA.
authors.forename: S Wade
authors.initials: SW
authors.lastname: Taylor
authors.affiliation: a The Fenway Institute, Fenway Health , Boston , USA.|d Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Elsesser
authors.affiliation: e Open Arms Healthcare Center , Jackson , USA.|f University of Mississippi Medical Center , Jackson , USA.
authors.forename: Leandro
authors.initials: L
authors.lastname: Mena
authors.affiliation: e Open Arms Healthcare Center , Jackson , USA.|g My Brother's Keeper, Inc. , Jackson , USA.|h School of Public Health , Jackson State University , Jackson , USA.
authors.forename: DeMarc
authors.initials: D
authors.lastname: Hickson
authors.affiliation: a The Fenway Institute, Fenway Health , Boston , USA.|i Harvard Medical School , Boston , USA.|j Beth Israel Deaconess Medical Center , Boston , USA.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D001294:Attitude to Health; D001364:Awareness; D001727:Bisexuality / Q000523:psychology / Q000706:statistics & numerical data; D001900:Boston; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008404:Massachusetts; D008922:Mississippi; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D065129:Pre-Exposure Prophylaxis / Q000706:statistics & numerical data*; D063505:Racism / Q000523:psychology* / Q000706:statistics & numerical data; D000072339:Sexual and Gender Minorities / Q000523:psychology* / Q000706:statistics & numerical data; D057545:Social Stigma; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Black American; MSM; PrEP; access; medical mistrust