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APHA Scientific Session and Event Listing

Recorded presentation

Judith Bradford, PhD, The Fenway Institute, Fenway Community Health Center, 7 Haviland Street, Boston, MA 02115, Sharon M. Coleman, MS, MPH, School of Public Health, Boston University, 374 Congress Street, Suite 502, Boston, MA 02110, 617-426-4447 x30, sharcole@bu.edu, and Ulrike Boehmer, PhD, Health Services, Boston University School of Public Health, 200 Springs Road (152), building 70, Bedford, MA 01730.

Background: Sexual minorities face unique barriers to healthcare access that are related to characteristics of the health care system, including insufficient cultural competence among providers. Healthcare providers who do not adequately understand the social and cultural affiliations, personal characteristics and behaviors, and unique needs of sexual minorities may not establish trusting relationships that facilitate patients' engagement in HIV care.

Methods: 422 HIV-infected sexual minorities enrolled in 8 outreach initiatives across the country completed an interview including questions related to engagement with provider. Quantitative data from participant interviews was supplemented with qualitative in-depth interviews with a subset of 30. A grounded-theory approach was used to analyze the narrative data.

Results: An engagement with provider score demonstrated significant differences (p=.02) based on sexual orientation. Sexual minority patients had a mean engagement score of 18.1 compared with a (more engaged) mean of 16.9 for others. Sexual minorities worried that their providers would ask about sexual practices (p=.002), drug use (p=.03), and described positive and negative provider experiences in the qualitative interviews. Positive relationships were associated with themes of collaboration with their providers and a sense that their questions were answered. Negative experiences were associated with perceived stigma from and perceived lack of connection with providers.

Conclusion: Improved patient quality of life, higher rates of medication adherence, and greater intent to follow provider advice have been associated with patient-provider positive engagement. Providers who develop cultural competence in sexual minority health can better assist these patients to become and remain engaged in HIV care.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Recognize one barrier to HIV care for sexual minorities.
• Describe the Engagement with Health Care Provider Scale.
• Develop a list of behaviors that may constitute cultural competency related to sexual minority health.

Keywords: HIV/AIDS, Cultural Competency

Presenting author's disclosure statement:

Not Answered

Recorded presentation