Reducing HIV Transmission Among Black MSM Who Use Drugs

Black men who have sex with men (MSM) face substantial disparities in HIV treatment among men in the United States. The use of drugs further compounds sexual risks, disrupts treatment adherence, and impacts health care utilization in this population. While more attention is being paid to the effects of drug use on HIV treatment and prevention, it is important to assess perceived health care provider stigma, perceived cultural incompetency, and mistrust of medical systems curtails in efforts to reach black MSM who use drugs.

A study presented at the Association of Nurses in AIDS Care Conference (ANAC 2019) in an oral abstract session by experts from the Johns Hopkins School of Nursing and Johns Hopkins School of Medicine explored preferences for health care and provider treatment to improve experiences for black MSM who use drugs. The study identified themes related to provider characteristics which emerged from in-depth qualitative interviews.

In an interview with Contagion®, Derek Dangerfield II, PhD, presenting author and assistant professor at Johns Hopkins School of Nursing, explained the impetus for the study and how provider attitudes play such a large role for people living with HIV.

The interviews were conducted with 24 black MSM with a history of drug use in Baltimore, Maryland, between December 2018 and March 2019. Participant eligibility criteria included being 18 years or older, racial identification as black or African American, anal intercourse with a male partner within the past 12 months, self-reported use of any opioid or stimulant in the past 30 days, and residence in the city of Baltimore.

Participants age ranged from 23 to 63 years, with a mean age of 43 years. Most participants (58.3%) were unemployed or had a disability and reported an annual income of less than $10,000. Of the 24 participants, 91% reported living with HIV.

Investigators conducted their interviews using a guide they created which included the following key topics: how health care facilities could better support drug-using black MSM, how providers could better support black MSM to help reduce substance use, and how to improve cultural competency toward black MSM among health care providers. Interview transcripts were coded in Atlast.ti 8.0 which were analyzed to identify themes.

Key themes which emerged were related to provider characteristics, screening preferences, patient care, and patient advocacy. Interviewees emphasized providers being open-minded and sincere, knowing local social services and resources, understanding drug use effects, providing mental health services, and clarifying treatment and health care recommendations.

Investigators concluded that their findings provide an opportunity to consider ways nurses and health care facilities could improve their practices to better meet the needs of black MSM.

The oral abstract, Exploring healthcare and provider preferences to reduce HIV transmission risk and improve health among drug-using Black men, was presented in an oral abstract session at ANAC 2019 in Portland, Oregon.