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01-07-2014 | Original Paper

A Study of Perceived Racial Discrimination in Black Men Who Have Sex with Men (MSM) and Its Association with Healthcare Utilization and HIV Testing

Authors: R. Irvin, L. Wilton, H. Scott, G. Beauchamp, L. Wang, J. Betancourt, M. Lubensky, J. Wallace, S. Buchbinder

Published in: AIDS and Behavior | Issue 7/2014

Abstract

In HPTN 061, a study of Black men who have sex with men (MSM), we evaluated the association of healthcare-specific racial discrimination with healthcare utilization and HIV testing among 1167 HIV-negative participants. Median age was 38 years, 41 % were uninsured, and 38 % had an annual household income <$10,000. Overall, 19 % reported healthcare-specific racial discrimination directed toward family, friend, or self; 61 % saw a healthcare provider in the previous 6 months and 81 % HIV tested within the past year. Healthcare-specific racial discrimination was positively associated with seeing a provider [adjusted odds ratio (AOR) = 1.4 (1.0, 2.0)] and HIV testing [AOR = 1.6 (1.1, 2.4)] suggesting that barriers other than racial discrimination may be driving health disparities related to access to medical care and HIV testing among Black MSM. These results contrast with previous studies, possibly due to measurement or cohort differences, strategies to overcome discrimination, or because of greater exposure to healthcare.

Healthy People 2010. http://www.healthypeople.gov/2010/Document/pdf/uih/2010uih.pdf. Accessed 27 Aug 2013.

National Healthcare Disparities Report nhdr11.pdf. http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/nhdr11.pdf. Accessed 27 Aug 2013.

HIV Surveillance—United States, 1981–2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6021a2.htm. Accessed 27 Aug 2013.

Prejean J, Song R, Hernandez A, et al. Estimated HIV incidence in the United States, 2006–2009. PLoS One. 2011;6(8):e17502. doi:10.1371/journal.pone.0017502.PubMedCentralPubMedCrossRef

Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS Lond Engl. 2007;21(15):2083–91. doi:10.1097/QAD.0b013e3282e9a64b.CrossRef

Millett GA, Peterson JL, Flores SA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380(9839):341–8. doi:10.1016/S0140-6736(12)60899-X.PubMedCrossRef

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (full printed version). http://books.nap.edu/openbook.php?record_id=10260. Accessed 27 Aug 2013.

Kressin NR, Petersen LA. Racial differences in the use of invasive cardiovascular procedures: review of the literature and prescription for future research. Ann Intern Med. 2001;135(5):352–66.PubMedCrossRef

López L, Wilper AP, Cervantes MC, Betancourt JR, Green AR. Racial and sex differences in emergency department triage assessment and test ordering for chest pain, 1997–2006. Acad Emerg Med. 2010;17(8):801–8. doi:10.1111/j.1553-2712.2010.00823.x.PubMedCrossRef

10.

Quality of Health Care in the United States: A Chartbook - leatherman_chbk_520 pdf.pdf. http://www.commonwealthfund.org/~/media/Files/Publications/Chartbook/2002/Apr/Quality%20of%20Health%20Care%20in%20the%20United%20States%20%20A%20Chartbook/leatherman_chbk_520%20pdf.pdf. Accessed 27 Aug 2013.

11.

Cohen C. The boundaries of blackness: AIDS and the breakdown of black politics. Chicago: University of Chicago Press; 1999.

12.

Mays VM, Cochran SD, Barnes NW. Race, race-based discrimination, and health outcomes among African Americans. Annu Rev Psychol. 2007;58:201–25. doi:10.1146/annurev.psych.57.102904.190212.PubMedCrossRef

13.

Washington H. Medical apartheid: the dark history of medical experimentation on black Americans from colonial times to the present. New York: Harlem Moon Press; 2008.

14.

Reverby S. Examining tuskegee: the infamous syphilis study and its legacy. Chapel Hill: University of North Carolina Press; 2009.

15.

Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2008;98(9 Suppl):S29–37.PubMedCentralPubMedCrossRef

16.

Wilton L, Herbst JH, Coury-Doniger P, et al. Efficacy of an HIV/STI prevention intervention for black men who have sex with men: findings from the many men, many voices (3MV) project. AIDS Behav. 2009;13(3):532–44. doi:10.1007/s10461-009-9529-y.PubMedCrossRef

17.

Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340(8):618–26. doi:10.1056/NEJM199902253400806.PubMedCrossRef

18.

Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19(2):101–10.PubMedCentralPubMedCrossRef

19.

Wejnert C, Le B, Rose CE, et al. HIV infection and awareness among men who have sex with men-20 cities, United States 2008 and 2011. PLoS One. 2013;8(10):e76878.

20.

Burgess DJ, Ding Y, Hargreaves M, van Ryn M, Phelan S. The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. J Health Care Poor Underserved. 2008;19(3):894–911. doi:10.1353/hpu.0.0063.PubMedCrossRef

21.

Bird ST, Bogart LM. Perceived race-based and socioeconomic status (SES)-based discrimination in interactions with health care providers. Ethn Dis. 2001;11(3):554–63.PubMed

22.

Kessler RC, Mickelson KD, Williams DR. The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. J Health Soc Behav. 1999;40(3):208–30.PubMedCrossRef

23.

Ayala G, Bingham T, Kim J, Wheeler DP, Millett GA. Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and black men who have sex with men. Am J Public Health. 2012;102(Suppl 2):S242–9. doi:10.2105/AJPH.2011.300641.PubMedCentralPubMedCrossRef

24.

Malebranche DJ, Peterson JL, Fullilove RE, Stackhouse RW. Race and sexual identity: perceptions about medical culture and healthcare among black men who have sex with men. J Natl Med Assoc. 2004;96(1):97–107.PubMedCentralPubMed

25.

Koblin BA, Mayer KH, Eshleman SH, et al. Correlates of HIV Acquisition in a Cohort of black men who have sex with men in the United States: HIV Prevention Trials Network (HPTN) 061. PLoS One. 2013;8(7):e70413. doi:10.1371/journal.pone.0070413.PubMedCentralPubMedCrossRef

26.

Blanchard J, Lurie N. R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care. J Fam Pract. 2004;53(9):721–30.PubMed

27.

Trivedi AN, Ayanian JZ. Perceived discrimination and use of preventive health services. J Gen Intern Med. 2006;21(6):553–8. doi:10.1111/j.1525-1497.2006.00413.x.PubMedCentralPubMedCrossRef

28.

Utsey SO, Belvet B, Hubbard RR, Fischer NL, Opare-Henaku A, Gladney LL. Development and Validation of the Prolonged Activation and Anticipatory Race-Related Stress Scale. J Black Psychol. 2012;. doi:10.1177/0095798412461808.

29.

Vital Signs: Health Insurance Coverage and Health Care Utilization—United States, 2006–2009 and January–March 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm59e1109a1.htm. Accessed 27 Aug 2013.

30.

Health care costs: a primer, key information on health care costs and their impact, 2012 7670-03.pdf. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7670-03.pdf. Accessed 27 Aug 2013.

31.

Wamala S, Merlo J, Boström G, Hogstedt C. Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. J Epidemiol Community Health. 2007;61(5):409–15. doi:10.1136/jech.2006.049999.PubMedCentralPubMedCrossRef

32.

Sellers RM, Shelton JN. The role of racial identity in perceived racial discrimination. J Pers Soc Psychol. 2003;84(5):1079–92. doi:10.1037/0022-3514.84.5.1079.PubMedCrossRef

33.

Paradies Y. A systematic review of empirical research on self-reported racism and health. Int J Epidemiol. 2006;35(4):888–901. doi:10.1093/ije/dyl056.PubMedCrossRef

34.

Mannheimer S, Wang L, Tieu H. Non adherence to HIV testing guidelines and late HIV testing is common among US black men who have sex with men (MSM). XIX International AIDS Conference, Washington, DC; 2012 (Conference abstract).

35.

Stanton MV, Jonassaint CR, Bartholomew FB, et al. The association of optimism and perceived discrimination with health care utilization in adults with sickle cell disease. J Natl Med Assoc. 2010;102(11):1056–63.PubMedCentralPubMed

36.

Bowleg L, Burkholder GJ, Massie JS, et al. Racial discrimination, social support, and sexual HIV risk among Black heterosexual men. AIDS Behav. 2013;17(1):407–18. doi:10.1007/s10461-012-0179-0.PubMedCrossRef

37.

Bogart LM, Landrine H, Galvan FH, Wagner GJ, Klein DJ. Perceived discrimination and physical health among HIV-positive Black and Latino men who have sex with men. AIDS Behav. 2013;17(4):1431–41. doi:10.1007/s10461-012-0397-5.PubMedCentralPubMedCrossRef

38.

HIV Testing and Risk Behaviors Among Gay, Bisexual, and Other Men Who Have Sex With Men-United States. http://www.cdc.gov/mmwr/pdf/wk/mm6247.pdf. Accessed 6 Dec 2013.

39.

Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm. Accessed 27 Aug 2013.

40.

Rasmussen HN, Scheier MF, Greenhouse JB. Optimism and physical health: a meta-analytic review. Ann Behav Med. 2009;37(3):239–56. doi:10.1007/s12160-009-9111-x.PubMedCentralPubMedCrossRef

41.

Krieger N. Embodying inequality: a review of concepts, measures, and methods for studying health consequences of discrimination. Int J Heal Serv. 1999;29(2):295–352.CrossRef

42.

Krieger N. Methods for the scientific study of discrimination and health: an ecosocial approach. Am J Public Health. 2012;102(5):936–44. doi:10.2105/AJPH.2011.300544.PubMedCentralPubMedCrossRef

43.

Mayer KH, Wang L, Koblin B, et al. Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among black men who have sex with men in 6 US Cities. PLoS One. 2014;9(1):e87298. doi:10.1371/journal.pone.0087298.PubMedCentralPubMedCrossRef

44.

Maulsby C, Millett G, Lindsey K, et al. HIV among black men who have sex with men (MSM) in the United States: a review of the literature. AIDS Behav. 2014;18(1):10–25. doi:10.1007/s104610130476-2.PubMedCrossRef

45.

Jeffries WL 4th, Marks G, Lauby J, Murrill CS, Millett GA. Homophobia is associated with sexual behavior that increases risk of acquiring and transmitting HIV infection among black men who have sex with men. AIDS Behav. 2013;17(4):1442–53. doi:10.1007/s10461-012-0189-y.PubMedCrossRef

46.

Bowleg L, Teti M, Malebranche DJ, Tschann JM. “It’s an uphill battle everyday”: intersectionality, low-income Black heterosexual men, and implications for HIV prevention research and interventions. Psychol Men Masc. 2013;14(1):25–34. doi:10.1037/a0028392.PubMedCentralPubMedCrossRef

Title: A Study of Perceived Racial Discrimination in Black Men Who Have Sex with Men (MSM) and Its Association with Healthcare Utilization and HIV Testing
Authors: R. Irvin
L. Wilton
H. Scott
G. Beauchamp
L. Wang
J. Betancourt
M. Lubensky
J. Wallace
S. Buchbinder
Publication date: 01-07-2014
Publisher: Springer US
Published in: AIDS and Behavior / Issue 7/2014
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-014-0734-y

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