Gay and Bisexual Men's Problematic Health Care Interactions: A Look at the Compounding Effects of Race and Sexual Orientation

Individuals who belong to both racial and sexual minorities are more vulnerable to “dual” discrimination. The current study identifies the extent to which race and sexual orientation together affect the likelihood of patients reporting problematic interactions with health care personnel. Survey data regarding healthcare experiences were collected from a diverse sample of 1554 men at two independent events that attract large gay and bisexual audiences. In addition to demographic information on race and sexual orientation, participants were asked to indicate if they had experienced one or more of ten forms of problematic interactions with health care personnel. Relationships between race, sexual orientation, and problematic health care interactions (PHCIs) were assessed using binary and multinomial logistic regression models. Of the entire sample, 37.8% of the men reported experiencing at least one PHCI. With regards to race, 49.7% of the African American men, 52.4% of the men of other races, and 41.9% of the Latino men reported experiencing at least one PCHI, whereas 34.4% of the White men reported the same. As for sexual orientation, 37.8% of gay men and 46.5% of bisexual men reported at least one PHCI, compared to 25.3% of heterosexual men. The intersection of race and sexual orientation amplified the odds of reported PHCIs. Specifically, non-White gay and bisexual men were between 4 and 12 times more likely than White heterosexual men to report PHCIs. These same men were between 1.5 and 5 times more likely than White gay men to report PHCIs. Health care providers may be negatively differentiating between patients based on race and sexual orientation, favoring the treatment and services provided to White heterosexual men. Implications for patient-perceived bias and discrimination in health care environments on quality of care assessments, health care utilization, and subsequent clinical outcomes are discussed.