Healthcare Stereotype Threat in Older Gay Men Living with HIV

Background/Purpose: Healthcare stereotype threat (HCST) pertains to individuals’ being reduced to group stereotypes within their healthcare encounters. Previous research found higher odds of reporting HCST among minorities, older adults, and obese individuals. HCST experiences have been found to be associated with greater mistrust of healthcare providers, poorer physical and mental health status, and lower odds of receipt of influenza vaccine. To-date, little research has been conducted to examine HCST among LGBT populations.

Research has shown that the LGBT population experiences health disparities, including higher rates of chronic conditions, substance use disorders, and mental health issues. Moreover, health status is further compromised for those living with HIV who generally have multiple chronic conditions, report lower general health, and have a higher rate of cardiovascular disease. Poorer health status leads to greater health care encounters and potential stigma and discrimination related to this population’s multiple marginalized identities (sexual minority, HIV status, and age). Given the potential negative effects associated with reports of HCST and the dearth of research investigating HCST among LGBT population, studies are needed to understand the health care experiences of LGBT individuals. Using the framework of HCST, the aim of this paper is to explore how older (50+) gay men living with HIV feel their identities affect how they receive healthcare services.

Methods: We conducted secondary data analysis using data from a qualitative study of older HIV positive gay men. Eleven Participants were purposively recruited from a Federally Qualified Health Center and were interviewed using a semi-structured interview guide. Using NVivo 12, two researchers independently analyzed the data following a deductive approach in line with framework analysis using the HCST as the framework. Codes were compared and discussed, with conflicts resolved by a third researcher until 100% agreement was reached.

Results: Researchers identified five risk factors for HCST (sexual orientation, HIV status, race/ethnicity, age, and gender), with five themes emerging from the transcripts. Coded data within each theme was dichotomized as either a positive or negative experience. Themes were: (1) interactions with healthcare providers, (2) attitude of healthcare providers, (3) healthcare setting, (4) sexual orientation of healthcare providers, and (5) participant attitude in receiving health services. Interactions with healthcare providers and the attitude of healthcare providers showed evidence of HCST with participants discussing instances where their marginalized identity (sexual orientation, HIV status, race/ethnicity) negatively affected how they received health services.

Conclusions: This study provides evidence of how marginalized identities (through the framework of HCST) impact the healthcare experiences of older gay men living with HIV. Interestingly, our study found that these identities can have a positive impact on individuals, rather than the solely negative experience documented in previous studies. Furthermore, our findings demonstrate that HCST is commonly experienced by gay men and needs to be further explored within the larger LGBT community.