Association Between Health Care Discrimination and Medical Mistrust Among Black Assigned Female at Birth Adults with Minoritized Sexual and Gender Identities in the United States

Purpose: Black sexually and gender minoritized (SGM) people who were assigned female at birth (AFAB) experience compounding health care inequities, barriers to equitable care, and disproportionately adverse health outcomes. Given prior literature indicating that both experienced and/or anticipated reported health care discrimination and medical mistrust may shape these health care experiences of Black SGM AFAB people, we sought to investigate the specific interplay between these two factors to bolster understanding of their relationship. Methods: In January and February 2023, we conducted a cross-sectional online survey of 156 Black SGM AFAB adults in the United States (U.S.) assessing their reported lifetime experiences of all-cause and gender-, race/ethnicity-, and weight-based discrimination in health care settings, in addition to their ratings of medical mistrust on the Medical Mistrust Index (MMI). Univariate statistics, analysis of variance, post hoc pairwise tests, and multivariable linear regression were conducted to assess measures of health care discrimination, medical mistrust, and covariates and their associations among the analytic sample (n = 130). Results: Most participants reported prior experiences of health care discrimination. Adjusting for demographic, socioeconomic, and health care factors, we identified an association between experiencing any-cause-, race/ethnicity-, or weight-based discrimination and significantly higher MMI scores. The association for gender-based discrimination was not statistically significant. Conclusion: Black SGM AFAB people who experience any-cause-, race/ethnicity-, or weight-based discrimination may be more likely to experience higher levels of medical mistrust. Identifying interventions and pathways to tackle health care discrimination and the systemic and structural drivers of medical mistrust will be critical to augmenting health care outcomes and experiences of Black SGM communities.

Black college women's preventive health behaviors: Applications of a Black Feminist-Womanist research paradigm

OBJECTIVE

The researchers applied Lindsay-Dennis' Black Feminist-Womanist research paradigm to Andersen's Behavioral Model for Health Service Use to guide initial research about Black American women's preventive health behaviors.

METHODS

This article highlights this application, using interpretive phenomenological analysis for qualitative questions assessing how 40 Black college women define health and their experiences in health care. This was part of a larger convergent parallel mixed-methods approach in a 2022 cross-sectional online survey.

RESULTS

Participants defined health as a concept involving health literacy, physical and mental health, and being free from health conditions or disease. Regarding health-related lived experiences, negative experiences were more frequently reported than positive experiences. However, many participants reported both positive and negative health care related experiences. Predisposing, enabling, and need factors were all present in qualitative responses.

CONCLUSIONS

This article highlights the fit of a Black Feminist-Womanist research paradigm to Andersen's model to better understand Black women's health experiences and illustrates ways that medical mistrust, health literacy, and past experiences with health care can influence health service use. Areas for future research on barriers and facilitators to preventive care and implications for reducing health disparities are also discussed.

Exploring pathways to successful aging among older black lesbians and sexual minority women: A focus on life satisfaction and intersectional factors

PURPOSE

Satisfaction with life is a core aspect of successful aging, which is influenced by a broad range of factors, including health, socioeconomic status, and social relationships. Black lesbians experience various social challenges, including racism, sexism, ageism, and heterosexualism, that may present as deterrents to aging successfully. To develop better policies and programs in support of successful aging among all adults, an understanding of the unique components associated with their intersecting identities must be explored. This study was carried out to gain a better understanding of how Black lesbians and other Black sexual minority women (BSMW) view successful aging within the context of life satisfaction.

METHODS

Inferential statistics were used to determine relationships between satisfaction with life (SWLS-3) and selected independent variables. Backward stepwise regression was conducted to ascertain significant relationships of the study outcome variable.

RESULTS

The respondents were 118 Black lesbians and other BSMW aged 50 and above. Independent t-tests showed that those living with a partner had a significantly higher SWLS-3. Backwards stepwise regression indicated the predictor variables for higher rates of SWLS-3 to be harmony in life, annual household income, and provider sensitivity/cultural competence to their patient being Black.

CONCLUSION

This study provides insight on factors increasing and diminishing satisfaction with life for aging Black lesbians and other BSMW. Future research should replicate this study with a more diverse and nationally representative sample, especially given the study limitations of having recruited a highly educated sample during a global pandemic.

Creating havens for Black lesbian elders during COVID-19

Black lesbians experience more adverse health outcomes and economic insecurity in older age than their White counterparts due to enduring a lifetime of marginalization associated with the intersections of race, gender, and sexual orientation. Yet, there is a lack of organizations dedicated to empowering and supporting this population. ZAMI NOBLA (National Organization of Black Lesbians on Aging) is the only Black lesbian led national organization in the United States solely invested in improving the wellbeing of Black lesbian elders. Throughout the COVID-19 pandemic, they worked in solidarity with community partners across the country to leverage technological innovation and community solidarity to combat ageist ideology and elevate the spaces in which Black lesbians and their networks were able to learn, heal, thrive, and live. The organization's efforts fostered solidarity across generations of lesbians and the wider LGBTQ + community.

Sexual Minority Women and Discriminatory Health Care Experiences: An Intersectional Evaluation Across Race and Ethnicity

OBJECTIVE

Health care discrimination contributes to medical mistrust among marginalized communities. Sexual minority women of color (SM-WOC) are marginalized because of the intersection of their sexual orientation, gender, and race/ethnicity and regularly report poor health care experiences at the intersection of these identities. However, research has yet to quantify differences in the prevalence of reported health care discrimination across SM women of various racial/ethnic backgrounds. As such, this study compared the rates of discriminatory treatment during the most recent medical appointment between SM-WOC (Black, Hispanic, Asian American, Native American) and White SM women.

METHODS

We used nationally representative data from the Association of American Medical Colleges survey of health care services. Data were collected from 2010 to 2019 from N = 1,499 SM women (n = 458 SM-WOC). Binary logistic regressions compared frequencies of reported identity-based discrimination between each minoritized racial/ethnic group to White SM women.

RESULTS

Across the sample, 33% of SM-WOC reported discrimination during their last medical appointment compared with 19% of White SM women. Discriminatory treatment was more common among every minoritized racial/ethnic group of SM women compared with White SM women, with variability in frequency of specific forms of identity-based discrimination across minoritized racial/ethnic groups.

CONCLUSIONS

Although discriminatory treatment during the last medical appointment was common for all SM women, prevalence was higher for SM-WOC compared with White SM women. Findings have important implications for policy and practice to reduce health disparities, such as targeted interventions for SM-WOC and provider trainings in cultural humility, implicit bias, and common microaggressions.

Sexual identity factors and minority stressors associated with healthcare stereotype threat and access to care among Black sexual minority women

Black sexual minority women (SMW) are disproportionately impacted by negative health outcomes, healthcare discrimination, and provider bias. Therefore, the purpose of this study was to investigate which sexual identity characteristics and minority stressors are associated with healthcare stereotype threat and healthcare access for Black SMW. Using secondary data from the Generations Study data, N = 142 Black and/or biracial cisgender women were analyzed using bivariate correlations and stepwise regression models. Healthcare stereotype threat was positively associated with higher perceptions of stigma, sexual identity concealment, and reports of sexual identity centrality. Healthcare access was affected by bisexual identity, masculine gender presentation, and sexual identity concealment. Improving Black SMW's healthcare utilization and experiences in healthcare settings is crucial for promoting health equity. Implications for healthcare providers and discussed.

Perceived HIV Invulnerability and PrEP Knowledge and Attitudes among Black Sexual Minority Women

Black women have disproportionate rates of HIV compared to women of all other racial groups. The purpose of this analysis was to investigate perceived HIV risk, HIV and STI testing behaviors, and PrEP knowledge and attitudes among Black sexual minority women (SMW) and examine differences based on their history of male sex partners. Secondary data analysis was conducted using data from the Generations Study. This analysis used a sample of N=149 participants who identified as Black cisgender women. Results showed Black SMW with a history of male sex partners reported a higher perceived risk of contracting HIV and significantly more frequent HIV and STI testing than those without a history of male sex partners. Overall, most of the sample was not familiar with PrEP, but one-third had favorable attitudes towards it, and half felt like they did not know enough about PrEP to form an opinion. Implications for culturally relevant public health campaigns and comprehensive sexuality education that integrate PrEP are included.

Patient-Provider Sexually Transmitted Infection Prevention Communication among Young Adult Sexual Minority Cisgender Women and Nonbinary Assigned Female at Birth Individuals

BACKGROUND

Health care providers are an important source of sexually transmitted infection (STI) prevention information for young adult sexual minority women (SMW). However, very few studies have described patient-provider STI communication in this understudied and underserved population. We explore sexual minority women's experiences communicating with health care providers about sexual health, with particular attention to STI prevention, to inform programs and practices that address their unique needs and concerns.

METHODS

We conducted 29 in-depth interviews with sexual minority cisgender women and nonbinary assigned female at birth (AFAB) individuals aged 18-36 years. The sample included White (55%), Asian (31%), Black (17.2%), and Latina (3.4%) participants. We used thematic analysis with deductive and inductive coding to identify themes related to patient-provider STI prevention communication.

RESULTS

Heteronormative health care provider assumptions inhibited participants' willingness to disclose their sexual orientation and discuss sexual health issues with providers. Most sexual health conversations focused on pregnancy and contraception, which many felt was irrelevant to them, and limited STI prevention recommendations to condom use. Participants reported that some providers lacked medical knowledge on AFAB-to-AFAB STI transmission and were not able to provide relevant STI prevention information. Providers' bias related to gender identity and race/ethnicity furthered some participants' mistrust generated from providers' heteronormative assumptions.

CONCLUSIONS

Our study describes several barriers that AFAB sexual minorities felt inhibited their patient-provider sexual health communication. Interventions are needed to improve patient-provider STI prevention conversations with AFAB sexual minorities so they can access the sexual health information they need to effectively protect themselves from STIs.