20th International AIDS Conference - Melbourne, Australia


WEPE354 - Poster Exhibition

Socialization experiences and structural factors as impediments to access to care and PrEP uptake among Black men who have sex with men in New York City

P. Wilson1, J. Garcia1, M. Philbin2, R. Parker1, J. Hirsch1

1Columbia University Mailman School of Public Health, Sociomedical Sciences, New York, United States, 2Columbia University, HIV Center for Clinical and Behavioral Studies, New York, United States

Background: Pre-Exposure Prophylaxis (PrEP) and other biomedical HIV interventions have shown promise in reducing HIV risk among men who have sex with men (MSM). In the U.S., media reports suggest that MSM have been slow to take up PrEP, notably by those most vulnerable to HIV infection, such as Black MSM (BMSM). This ethnographic study aims to identify social, institutional, and structural factors that shape perceptions of health among BMSM and limit opportunities for accessing quality health care and utilizing PrEP.
Methods: Twenty-six BMSM participated in three in-depth interviews; each provided over 4.5 hours of interview data. Participants varied with regard to age, sexual identity, and social class. In addition, 60-minute key informant interviews were conducted with 13 community leaders and service providers. All interviews were audio recorded, transcribed, and coded. Data were analyzed within and across cases to explore issues related to access to and utilization of health care.
Results: Participants'' use of health care and perceptions of mainstream medicine were influenced by an assortment of psychological, social, and structural factors. Three main themes emerged in the analysis:
(1) early socialization experiences shape uptake of health care and a lack of trust in mainstream medicine;
(2) BMSM negotiate personal perceptions of the importance of health, essential needs, and life projects; and
(3) BMSM''s experiences with public vs. private medicine, and their experiences being incarcerated and living in poverty, shape their health care expectations.
Two critical factors that cut across themes were peer-influenced conceptions of masculinity and stigma tied to race, sexuality, and HIV. These factors structured health-related perceptions, experiences, and behaviors across the life course.
Conclusions: Understanding uptake of PrEP and access to health care among BMSM requires attending to the impact of psychological, social, and structural factors, which work in concert to reduce perceptions among BMSM of the relevance of health care and increase the likelihood that BMSM have negative experiences as health care users. Structural interventions and combination prevention approaches that improve systems of care and change norms around the importance of health are needed in order to optimize PrEP uptake and health care usage among BMSM.

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