MOVED to POSTER SESSION I, 69A: Inappropriate HIV Healthcare Delivery and Patient Recommendations for Improvement: A Qualitative Study of African American/Black Gbt Patient Perspectives

Introduction:

African American/Black gay/bisexual men and transgender women (AA GBT) suffer from disproportionately high rates of HIV. Additionally, disparities in healthcare of AA GBT are associated with mistrust/challenges regarding disclosure about one’s sexuality/gender. While provider competencies for culturally appropriate healthcare with GBT are established by various professional healthcare organizations, these competencies are not derived directly from AA GBT communities themselves, and therefore may not be culturally appropriate or generalizable to the needs of AA GBT populations. Indeed, a recent qualitative attempt to obtain information directly from a broad LGBTQI population produced competencies that differed meaningfully from those developed by professional organizations. Exploring the healthcare experiences of AA GBT is needed not only to improve culturally competent care for these high risk populations, but also to increase their retention and engagement in healthcare services that are necessary for HIV prevention and treatment. As a first step toward obtaining such information, this qualitative study aims to identify examples of inappropriate healthcare behaviors and how to address them from the perspective of AA GBT.

Methods:

Using a semi-structured interview guide, 12 AA GBT participants (6 gay/bisexual men and 6 transgender women) were asked open-ended questions about their experience discussing the following topics with healthcare providers: sexuality/gender, sexual health, HIV risk behaviors, HIV testing, and PrEP. All interviews were recorded and transcribed verbatim, and text was analyzed using directed content analysis.

Results:

Preliminary analyses revealed examples from AA GBT that described inappropriate provider healthcare behaviors such as failing to use the correct pronoun and/or repeatedly using the incorrect pronoun, lack of proper health information disclosure, uncomfortable body language and demeanor, unacceptable tone of voice, and incorrect assumptions about sexuality/gender. Additional examples included providers being too forward in their way of asking questions or providing recommendations. Regarding ways to improve, AA GBT stressed the importance of providers delivering more detailed health information, disclosing patient confidentiality/privacy, and developing a personal bond with the patient as a precursor to discussing difficult topics. AA GBT also discussed the importance of having a culturally sensitive, welcoming, understanding and empathetic attitude, both internally and externally.

Conclusions:

The examples of inappropriate behavior and improvement recommendations identified from the perspective of AA GBT provide important information/implications related to developing healthcare provider competencies for use with AA GBT populations. These include highlighting the need for addressing lack of and access to culturally competent care, and the behavioral manifestations of and gaps in existing provider competency recommendations.