The Role of Cultural Distance in HIV Care provision for Young Black Gay, Bisexual and other Men Who Have Sex with Men Living with HIV in Atlanta, GA Open Access

Abstract

Background: Young black gay, bisexual, and other men who have sex with men (YB-GBMSM) are disproportionately impacted by HIV, and often face barriers to engagement in care. There is a paucity of research examining strengths of, and challenges facing HIV service and care providers working with this population. We aimed to learn more about the role of cultural distance in the care YB-GBMSM living with HIV receive in Atlanta, Georgia.

 

Methods: We conducted 28 qualitative interviews with key informants from healthcare and community-based organizations that serve YB-GBMSM. Interview domains included descriptions of service provision, personal identity, and cultural competency. We utilized rigorous team coding to and thematic analysis to identity our results.

 

Results: Most (86%) of the key informants were black, 25% were women, and 80% identified as non-heterosexual. Key informants’ personal identity characteristics influenced the type of support that they offered to YB-GBMSM. Women often described providing support through nurturing and caregiving methods. Black gay men offered mentorship from personal experiences as a feature of their supportive practices. Participants discussed the need for improving representation of YB-GBMSM among providers, highlighting the role of cultural distance as contributing to gaps in their understanding of the experiences of YB-GBMSM.

 

Conclusions: The racial, sexual, and gender identity of HIV care and service providers influenced their approach and orientation in offering services and support to YB-GBMSM. Efforts to increase the representation of YB-GBMSM in the public health workforce are needed to decrease cultural distance. 

Table of Contents

Chapter 1: Introduction 1

Introduction and Rationale 1

Problem Statement 5

Statement of Purpose 6

Research Questions 6

Significance Statement 7

Definition of Terms 7

Chapter 2: Literature Review 8

HIV in the United States Among GBMSM 8

Increased Risk of HIV for Black GBMSM 9

HIV Care Continuum 10

Healthcare Experiences for YB-GBMSM 12

Discordant and Concordant Relationships Between Client and Provider 14

Cultural Competency 15

Cultural Distance 16

Chapter 3: Manuscript 18

Abstract 18

Introduction 19

Methods 23

Context 23

Participants 24

Design 25

Thematic Analysis 25

Results 26

Discussion 37

Limitations 43

Conclusions 44

Table 1: Participant Demographics 45

CHAPTER 4: RECOMMENDATIONS 46

REFERENCES 50

APPENDIX 1: CULTURAL DISTANCE SCALE 52

APPENDIX 2: SELF-RATED CULTURAL COMPETENCE INSTRUMENT 53

APPENDIX 3: IN-DEPTH INTERVIEW GUIDE 54

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Black MSM cultural distance cultural competency patient-provider relationship HIV/AIDS
Committee Chair / Thesis Advisor	Hussen, Sophia, Emory University

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