Shared decision making for HIV pre-exposure prophylaxis (PrEP) with black transgender women.

Shared decision making is a collaborative process intended to develop a treatment plan that considers both the patient's preferences and the health provider's medical recommendations. It is one approach to reducing healthcare disparities by improving patient-provider communication and subsequent health outcomes. This study examines shared decision making about HIV pre-exposure prophylaxis (PrEP) with Black transgender women in Chicago, Illinois, USA, given high prevalence of HIV and disparities in PrEP use. Black transgender women were recruited online and in-person to participate in semi-structured interviews (n = 24) and focus groups (2; n = 14 total), conducted between 2016 and 2017. Iterative thematic content analysis took place. Analysis revealed that internalised transphobia and racism, combined with stigma from service providers, prevented disclosure of gender and sexual identity to providers. Stigma about PrEP as it relates to Black transgender women results in stereotype threat, which undermines patient-provider trust and deters shared decision making for PrEP. Shared decision making promotes cultural competence and humility and builds trust within the patient-provider relationship, leading to better communication and less stigma. The involvement of peers may be one way to mitigate stigma for Black transgender women around PrEP, promote cultural competence within organisations, and empower engagement in shared decision making for HIV prevention.

Shared decision-making around anal cancer screening among black bisexual and gay men in the USA.

Shared decision-making is a strategy to achieve health equity by strengthening patient-provider relationships and improve health outcomes. There is a paucity of research examining these factors among patients who identify as sexual or gender minorities and racial/ethnic minorities. Through intrapersonal, interpersonal and societal lenses, this project evaluates the relationship between intersectionality and shared decision-making around anal cancer screening in Black gay and bisexual men, given their disproportionate rates of anal cancer. Thirty semi-structured, one-on-one interviews and two focus groups were conducted during 2016-2017. Participants were asked open-ended questions regarding intersectionality, relationships with healthcare providers and making shared decisions about anal cancer screening. Forty-five individuals participated - 30 in individual interviews and 15 in focus groups. All participants identified as Black and male; 13 identified as bisexual and 32 as gay. Analysis revealed that the interaction of internalised racism, biphobia/homophobia, provider bias and medical apartheid led to reduced healthcare engagement and discomfort with discussing sexual practices, potentially hindering patients from engaging in shared decision-making. Non-judgemental healthcare settings and provider relationships in which patients communicate openly about each aspect of their identity will promote effective shared decision-making about anal cancer screening, and thus potentially impact downstream anal cancer rates.