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 Pubblico
Silverberg, Mathilde (Spring 2019)
Published
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
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