Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Identifying social and economic barriers to regular care and treatment for Black men who have sex with men and women (BMSMW) and who are living with HIV: a qualitative study from the Bruthas cohort

Authors: Emily A. Arnold, John Weeks, Michael Benjamin, William R. Stewart, Lance M. Pollack, Susan M. Kegeles, Don Operario

Published in: BMC Health Services Research | Issue 1/2017

Login to get access

Abstract

Background

There is little research regarding the ability of Black men who have sex with men and women (BMSMW) to access and maintain HIV-related health care and treatment adherence. This population, who often insist on secrecy about their same-sex desire, may experience unique barriers to seeking regular care and treatment.

Methods

From March 2011-April 2014, we recruited 396 BMSMW in the San Francisco Bay Area to be enrolled in our randomized controlled trial. At baseline we administered a behavioral survey assessing: demographics, homelessness, employment, history of incarceration, HIV status and disclosure practices, care and treatment adherence. 64 men reported living with HIV at intake. To learn more about their experiences, we recruited N = 25 to participate in qualitative interviews, which were conducted April-December 2014. Topics included: current living situation, diagnosis story, disclosure practices, experiences of accessing and maintaining care and treatment, and HIV-related stigma. Recordings were transcribed and coded for major themes.

Results

Despite being located in an area where treatment is plentiful, men faced social and economic barriers to maintaining regular care and treatment adherence. Several findings emerged to shed light on this quandary: (1) Competing needs particularly around attaining stable housing, food security, and money created barriers to treatment and care; (2) Side effects of HIV medications discouraged men from adhering to treatment; (3) Provider and Institutional level characteristics influenced care engagement; (4) Disclosure and social support made a difference in care and treatment behaviors; and (5) Participants expressed a desire for group-based intervention activities to support treatment and care among HIV+ BMSMW. Inadequate engagement in the continuum of care for HIV was born out in the quantitative data where 28% of participants did not know their Viral Load.

Conclusions

A holistic approach to HIV health for BMSMW would appear to translate to better outcomes for men living with HIV, where a goal of viral suppression must also include attending to their basic social and economic support needs.
Literature
1.
2.
The White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. Washington, DC: The White House Office of National AIDS Policy; 2010.
3.
Morin SF, Kelly JA, Charlebois ED, Remien RH, Rotheram-Borus MJ, Cleary PD. Responding to the National HIV/AIDS Strategy-setting the research agenda. J Acquir Immune Defic Syndr. 2011;57(3):175–80.CrossRefPubMedPubMedCentral
4.
Centers for Disease Control and Prevention. HIV Surveillance Report. Atlanta, GA: Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; 2012.
5.
Millett GA, Peterson JL, Flores SA, Hart TA, Jeffries WL, Wilson PA, Rourke SB, Heilig CM, Elford J, Fenton KA, 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.CrossRefPubMed
6.
Prejean J, Song R, Hernandez A, Ziebell R, Green T, Walker F, Lin LS, An Q, Mermin J, Lansky A, et al. Estimated HIV incidence in the United States, 2006–2009. PLoS One. 2011;6(8):e17502.CrossRefPubMedPubMedCentral
7.
Hightow-Weidman LB, Jones K, Phillips 2nd G, Wohl A, Giordano TP. Baseline clinical characteristics, antiretroviral therapy use, and viral load suppression among HIV-positive young men of color who have sex with men. AIDS Patient Care STDs. 2011;25 Suppl 1:S9–S14.CrossRefPubMedPubMedCentral
8.
Thames AD, Moizel J, Panos SE, Patel SM, Byrd DA, Myers HF, Wyatt GE, Hinkin CH. Differential predictors of medication adherence in HIV: findings from a sample of African American and Caucasian HIV-positive drug-using adults. AIDS Patient Care STDs. 2012;26(10):621–30.CrossRefPubMedPubMedCentral
9.
Alameda County Department of Health. HIV in Alameda County 2012–2014. Oakland: HIV Epidemiology and Surveillance Unit; 2016.
10.
San Francisco County Department of Health. HIV Epidemiology Annual Report 2014. San Francisco: Population Health Division; 2015.
11.
Maulsby C, Millett G, Lindsey K, Kelley R, Johnson K, Montoya D, Holtgrave D. A systematic review of HIV interventions for black men who have sex with men (MSM). BMC Public Health. 2013;13(1):625.CrossRefPubMedPubMedCentral
12.
Lapinski MK, Braz ME, Maloney EK. The down low, social stigma, and risky sexual behaviors: insights from African-American men who have sex with men. J Homosex. 2010;57(5):610–33.CrossRefPubMed
13.
Harawa NT, Williams JK, Ramamurthi HC, Manago C, Avina S, Jones M. Sexual behavior, sexual identity, and substance abuse among low-income bisexual and non-gay-identifying African American men who have sex with men. Arch Sex Behav. 2008;37(5):748–62.CrossRefPubMedPubMedCentral
14.
Bingham TA, Harawa NT, Williams JK. Gender role conflict among African American men who have sex with men and women: associations with mental health and sexual risk and disclosure behaviors. Am J Public Health. 2013;103(1):127–33.CrossRefPubMedPubMedCentral
15.
Operario D, Smith CD, Arnold E, Kegeles S. Sexual risk and substance use behaviors among African American men who have sex with men and women. AIDS Behav. 2011;15(3):576–83.CrossRefPubMed
16.
Singh S, Hu X, Wheeler W, Hall HI. HIV diagnoses among men who have sex with men and women-United States and 6 dependent areas, 2008–2011. Am J Public Health. 2014;104(9):1700–6.CrossRefPubMedPubMedCentral
17.
Dyer TP, Regan R, Pacek LR, Acheampong A, Khan MR. Psychosocial vulnerability and HIV-related sexual risk among men who have sex with men and women in the United States. Arch Sex Behav. 2015;44(2):429–41.CrossRefPubMed
18.
Jeffries WL. Beyond the bisexual bridge: sexual health among U.S. men who have sex with men and women. Am J Prev Med. 2014;47(3):320–9.CrossRefPubMed
19.
Friedman MR, Stall R, Silvestre AJ, Mustanski B, Shoptaw S, Surkan PJ, Rinaldo CR, Plankey MW. Stuck in the middle: longitudinal HIV-related health disparities among men who have sex with men and women. J Acquir Immune Defic Syndr. 2014;66(2):213–20.PubMedPubMedCentral
20.
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.PubMedPubMedCentral
21.
Operario D, Smith CD, Arnold E, Kegeles S. The Bruthas Project: evaluation of a community-based HIV prevention intervention for African American men who have sex with men and women. AIDS Educ Prev. 2010;22(1):37–48.CrossRefPubMed
22.
Arnold EA, Operario D, Cornwell S, Benjamin M, Smith CD, Lockett G, Kegeles SM. The Development of a Counseling-Based HIV Prevention Intervention for African American Men Who Have Sex With Men and Women: The Bruthas Project. AIDS Educ Prev. 2015;27(6):505–21.CrossRefPubMedPubMedCentral
23.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRefPubMed
24.
Ritchie J, Lewis J. Qualitative Research Practice: A Guide for Social Science Students and Researchers. London: Sage; 2003.
25.
Whittle HJ, Palar K, Hufstedler LL, Seligman HK, Frongillo EA, Weiser SD. Food insecurity, chronic illness, and gentrification in the San Francisco Bay Area: An example of structural violence in United States public policy. Soc Sci Med. 2015;143:154–61.CrossRefPubMed
26.
Beane SN, Culyba RJ, DeMayo M, Armstrong W. Exploring the medical home in Ryan White HIV care settings: a pilot study. J Assoc Nurses AIDS Care. 2014;25(3):191–202.CrossRefPubMedPubMedCentral
27.
Cahill SR, Mayer KH, Boswell SL. The Ryan White HIV/AIDS Program in the Age of Health Care Reform. Am J Public Health. 2015;105(6):1078–85.CrossRefPubMed
28.
Prado G, Feaster DJ, Schwartz SJ, Pratt IA, Smith L, Szapocznik J. Religious involvement, coping, social support, and psychological distress in HIV-seropositive African American mothers. AIDS Behav. 2004;8(3):221–35.CrossRefPubMedPubMedCentral
29.
Warren-Jeanpiere L, Dillaway H, Hamilton P, Young M, Goparaju L. Taking it one day at a time: African American women aging with HIV and co-morbidities. AIDS Patient Care STDs. 2014;28(7):372–80.CrossRefPubMedPubMedCentral
30.
Abara WE, Smith L, Zhang S, Fairchild AJ, Heiman HJ, Rust G. The influence of race and comorbidity on the timely initiation of antiretroviral therapy among older persons living with HIV/AIDS. Am J Public Health. 2014;104(11):e135–41.CrossRefPubMedPubMedCentral
31.
Okoro O, Odedina FT. Improving medication adherence in African-American women living with HIV/AIDS: Leveraging the provider role and peer involvement. AIDS Care. 2016;28(2):179–85.CrossRefPubMed
32.
Shah K, McMahon JM, Trabold N, Aidala AA, Chen M, Pouget ER, Simmons J, Klostermann K. Determinants of physical and global functioning in adult HIV-positive heterosexual men. AIDS Care. 2015;27(9):1079–86.CrossRefPubMedPubMedCentral
Metadata
Title
Identifying social and economic barriers to regular care and treatment for Black men who have sex with men and women (BMSMW) and who are living with HIV: a qualitative study from the Bruthas cohort
Authors
Emily A. Arnold
John Weeks
Michael Benjamin
William R. Stewart
Lance M. Pollack
Susan M. Kegeles
Don Operario
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2011-z

Other articles of this Issue 1/2017

BMC Health Services Research 1/2017 Go to the issue

Research article

A qualitative study of clinic and community member perspectives on intervention toolkits: “Unless the toolkit is used it won’t help solve the problem”

Research article

Challenges and potential improvements in the admission process of patients with spinal cord injury in a specialized rehabilitation clinic – an interview based qualitative study of an interdisciplinary team

Research article

Cultural adaptation of a pediatric functional assessment for rehabilitation outcomes research

Research article

The development and appraisal of a tool designed to find patients harmed by falsely labelled, falsified (counterfeit) medicines

Research article

Preventing blood transfusion failures: FMEA, an effective assessment method

Research article

Using technology to engage hospitalised patients in their care: a realist review