RESUMO
OBJECTIVE: Evaluate associations between racialized and homophobia-based police harassment (RHBPH) and healthcare distrust and utilization among Black Sexual Minority Men (BSMM). METHODS: We utilized data from a longitudinal cohort study from HIV Prevention Trials Network (HPTN) 061 with baseline, six and 12 month follow-up assessments. Using multivariable analysis, we evaluated associations between RHBPH and healthcare distrust and utilization reported at the 6 and 12 month visits. RESULTS: Of 1553 BSMM present at baseline, 1160 were available at six-month follow-up. In multivariable analysis, increasing frequency of RHBPH was associated with increasing levels of distrust in healthcare providers (aOR 1.31, 95% CI: 1.00, 1.74) and missing 50% or more of healthcare visits at six-month follow-up (aOR 1.93, 95% CI: 1.09, 3.43). CONCLUSIONS: Recent experiences of RHBPH are associated with reduced trust in and access to healthcare among BSMM, with more frequent RHBPH associated with greater vulnerability.
Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Masculino , Humanos , HIV , Estudos Longitudinais , Polícia , Infecções por HIV/epidemiologia , Atenção à SaúdeRESUMO
Characterization of structural barriers that impede the receipt of HIV prevention and care services is critical to addressing the HIV epidemic among Black men who have sex with men (BMSM). This study investigated the utilization of HIV prevention and general care services among a non-clinic-based sample of BMSM who reported at least one structural barrier to engagement in care. Proportions of participants who had received HIV prevention services and general care services in different settings were compared using Fisher's exact test and correlates of service receipt were assessed using logistic regression. Among 75 BMSM, 60% had accessed a community-based clinic, 21% had accessed a primary care setting, and 36% had accessed an acute care setting in the last 6 months. Greater proportions of participants who had accessed community-based clinics received HIV prevention services during these visits (90%) compared to those who had accessed primary care (53%) and acute care (44%) settings (p = .005). Opportunities for BMSM to receive HIV prevention interventions differed by care setting. Having access to health care did not necessarily facilitate the uptake of HIV prevention interventions. Further investigation of the structurally rooted reasons why BMSM are often unable to access HIV prevention services is warranted.
Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Negro ou Afro-Americano/psicologia , Infecções por HIV/diagnóstico , Homossexualidade Masculina/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Serviços de Saúde Comunitária , Estudos Transversais , Atenção à Saúde , District of Columbia , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Homossexualidade Masculina/etnologia , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Análise de Regressão , Adulto JovemRESUMO
Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.