Category: Men’s Health

Discrimination and Health Part I: LGBTQ+ Americans

Past research has suggested that discrimination can impact health outcomes – perhaps through vehicles such as stress of daily interactions and negative experiences with the healthcare system. One group whose experiences with discrimination can be linked to negative health outcomes is LGBTQ+ Americans. A study found that over half of LGBTQ people have experience slurs and offensive comments, and over half have been sexually harassed or experienced violence, or had an LGBTQ friend or family member experience such trauma.

We can make the connection between discrimination and trauma through various factors. One is through microaggressions –  seemingly harmless daily interactions with others who express, in this case, homophobic or transphobic views. These have been found to negatively impact health. Another is through discrimination within the healthcare system that lead LGBTQ Americans to seek healthcare less frequently. 18% of this population has avoided necessary medical care. Various forms of discrimination they face at the hands of medical professionals, police, and community members are much worse for those of color and those who are transgender.

Unfortunately, we can already see the health outcomes of discrimination to this population – they have higher rates of psychiatric disorders, substance dependence (including higher tobacco use), and suicide; lesbian women are less likely to get preventative services for cancer, and gay men are at higher risk for certain STIs.

How can we work to eliminate these gaps, even when interpersonal discrimination may take longer to tackle as our culture continues to evolve? HealthyPeople2020 provides several recommendations. First, healthcare providers should discuss sexual orientation and gender identity (SOGI) respectfully with patients, and collect data on it. Medical students should be trained in LGBTQ culturally-responsive care. In addition, we must be spokespeople against legal discrimination of this population in social services such as employment, housing, and health insurance.

Sources:

https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

https://www.npr.org/documents/2017/nov/npr-discrimination-lgbtq-final.pdf

https://www.centerforhealthjournalism.org/2017/11/08/how-racism-and-microaggressions-lead-worse-health

https://www.psychologytoday.com/us/blog/microaggressions-in-everyday-life/201011/microaggressions-more-just-race

http://www.apa.org/topics/health-disparities/fact-sheet-stress.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747726/pdf/nihms134591.pdf

What’s going on with the HPV vaccine?

HPV is the most common STI, and 9 of every 10 people will have an infection at some point in their lives (1).  This virus can cause cancers in the cervix, penis, mouth, and oropharynx (2), and it also causes genital warts (3).  Even though a vaccine exists against HPV, less than half of teens are up to date on all of their doses of these shots (2).

Part of the reason behind these low vaccination rates are due to parents concerns regarding vaccine safety and fear that vaccination will encourage sexual activity (4).  Though all vaccines, including this one, have potential side effects, the HPV vaccine is considered safe (4). Additionally, studies have shown that the HPV vaccine does not make teens more likely to start having sex (4).

The way providers approach talking about the HPV has also influenced vaccine rates, and strong provider endorsement seems to improve vaccinations (5).  On Monday, March 19, Chris Noronha spoke with the Interdisciplinary Health Communications Class about the work he is doing with Noel Brewer on provider communication regarding the HPV vaccine.  They have found that when providers mention the HPV vaccine in the same list as other vaccines that are due at age 11, vaccination rates increase.

If you’re interested in the HPV vaccine, it may not be too late.  You can receive the series through age 26 (1).  Contact your provider if you’re interested.

 

Works Cited
  1. Centers for Disease Control and Prevention. Human Papillomavirus (HPV) Vaccine Safety. Centers for Disease Control and Prevention. [Online] January 30, 2018. https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html.
  2. Aubrey, Allison. This Vaccine Can Prevent Cancer, But Many Teenagers Still Don’t Get It. National Public Radio. [Online] February 19, 2018. https://www.npr.org/sections/health-shots/2018/02/19/586494027/this-vaccine-can-prevent-cancer-but-many-teenagers-still-dont-get-it.
  3. Centers for Disease Control and Prevention. What is HPV. Centers for Disease Control and Prevention. [Online] December 20, 2016. https://www.cdc.gov/hpv/parents/whatishpv.html.
  4. —. Talking to Parents About HPV vaccine. Centers for Disease Control and Prevention. [Online] December 2016. https://www.cdc.gov/hpv/hcp/for-hcp-tipsheet-hpv.pdf.
  5. Narula, Tara. HPV vaccine: Why aren’t children getting it? CBS News. [Online] July 23, 2017. https://www.cbsnews.com/news/hpv-vaccination-cancer-prevention-dr-tara-narula/.

 

 

How many teens are sexting?

When we go on the internet and listen to stories, we often hear comments about sexting among teens.  With all of this talk, it may sound like this is something that all teens are doing.  However, according to a study published this week by JAMA Pediatrics, only about 14.8% of teens have sent these messages, and approximately 27.4% of teens have received a sext [1].  This means that roughly 17 out of 20 teens have never sent sexually explicit images, videos, or messages.

Though this rate is lower than we may have expected, sexting is becoming more commonplace, and that is cause for concern. Many teens, view sexting as private and therefore safe.  However, approximately 12%, are forwarding sexts without consent of the sender [1]. Additionally, many teens don’t realize that even though some messaging apps that allow video and image sharing appear private, they may not be [2].

Often times, sexting is a normal by-product of teens trying to establish their identities and wanting to explore their sexuality [2].  However, many teens just are not aware of the dangers that can come with sexting.  Along with these concerns, teens just need to be reminded that it’s not OK for them to be pressured to share more of their bodies than they’re comfortable, and that consent is theirs to give.

[1]  Madigan, S., Ly, A., & Rash, C. L. (2018, February 26). Prevalence of Multiple Forms of Sexting Behavior Among Youth. Journal of the American Medical Association Pediatrics. doi:10.1001/jamapediatrics.2017.5314

[2]  Gabriel, E. (2018, February 26). 1 in 4 young people has been sexted, study finds. Retrieved from CNN: https://www.cnn.com/2018/02/26/health/youth-sexting-prevalence-study/index.html

A Queer Health Reading List

The following is a list of books and articles related to queer health that might be useful for some individuals interested in the topic. The list is by no means exhaustive.

HIV:

  1. Race, K. (2016). Reluctant Objects Sexual Pleasure as a Problem for HIV Biomedical Prevention. GLQ: A Journal of Lesbian and Gay Studies22(1), 1-31.
  2. Gonzalez, O. R. (2010). Tracking the bugchaser: Giving the gift of HIV/AIDS. Cultural Critique75(1), 82-113.

Research & Infrastructures:

  1. Nguyen, V. K. (2009). Government-by-exception: Enrolment and experimentality in mass HIV treatment programmes in Africa. Social Theory & Health7(3), 196-217.
  2. Murphy, M. (2017). The economization of life. Duke University Press.

Regarding MSM:

  1. Boellstorff, T. (2011). But do not identify as gay: A proleptic genealogy of the MSM category. Cultural Anthropology26(2), 287-312.
  2. Young, R. M., & Meyer, I. H. (2005). The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American journal of public health95(7), 1144-1149.

Medical interventions:

  1. Epstein, Steven. 2010. “The great undiscussable: Anal cancer, HPV, and gay men’s health.” In Three shots at prevention: The HPV vaccine and the politics of medicine’s simple solutions, edited by Keith Wailoo, Julie Livingston, Steven Epstein, and Robert Aronowitz. Baltimore: Johns Hopkins University Press, pp. 61 -90.
  2. Blackwell, Courtney, Jeremy Birnholtz, and Charles Abbott. 2014. Seeing and being seen: Co-situation and impression formation using Grindr, a location-aware gay dating app. New Media & Society: 1461444814521595.

Precarity:

  1. Butler, J. (2006). Precarious life: The powers of mourning and violence. Verso.

PrEP:

  1. Fiereck, K. J. (2015). Cultural Conundrums: The Ethics of Epidemiology and the Problems of Population in Implementing Pre-Exposure Prophylaxis. Developing World Bioethics15(1), 27–39. http://doi.org/10.1111/dewb.12034
  2. Singh, J. A., & Mills, E. J. (2005). The Abandoned Trials of Pre-Exposure Prophylaxis for HIV: What Went Wrong? PLoS Medicine2(9), e234. http://doi.org/10.1371/journal.pmed.0020234
  3. Calabrese, S. K., Earnshaw, V. A., Underhill, K., Hansen, N. B., & Dovidio, J. F. (2014). The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS Behav, 18(2), 226-240. doi:10.1007/s10461-013-0675-x
  4. Calabrese, S. K., Magnus, M., Mayer, K. H., Krakower, D. S., Eldahan, A. I., Hawkins, L. A. G., . . . Dovidio, J. F. (2017). “Support Your Client at the Space That They’re in”: HIV Pre-Exposure Prophylaxis (PrEP) Prescribers’ Perspectives on PrEP-Related Risk Compensation. AIDS Patient Care STDS, 31(4), 196-204. doi:10.1089/apc.2017.0002
  5. Calabrese, S. K., & Underhill, K. (2015). How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores”. Am J Public Health, 105(10), 1960-1964. doi:10.2105/ajph.2015.302816
  6. Dumit, J. (2012). Drugs for life: how pharmaceutical companies define our health. Duke University Press.

Trans health:

  1. Plemons, E. D. (2014). It is as it does: Genital form and function in sex reassignment surgery. Journal of Medical Humanities35(1), 37-55.
  2. Preciado, Paul Beatriz. 2013. Testo junkie: Sex, drugs, and biopolitics in the pharmacopornographic era. New York: The Feminist Press at CUNY. (End of “The Micropolitics of Gender,” pp. 365 – 398).
  3. Spade, Dean. 2006. “Mutilating Gender.” In The Transgender Studies Reader, edited by Susan Stryker and Stephen Wittle. New York: Routledge, 315-32.
  4. Currah, Paisley. 2008. Expecting bodies: the pregnant man and transgender exclusion from the Employment Non-Discrimination Act. Women’s Studies Quarterly, 36(3&4).
  5. Crawford, Lucas Cassidy. 2008. Transgender without organs? Mobilizing a geo-affective theory of gender modification. WSQ: Women’s Studies Quarterly, 36(3&4): 127-43.
  6. Butler, J. (2001). Doing justice to someone: Sex reassignment and allegories of transsexuality. GLQ: A Journal of Lesbian and Gay Studies7(4), 621-636.
  7. Karaian, Lara. 2013. Pregnant men: Repronormativity, critical trans theory and the re (conceive)ing of sex and pregnancy in law. Social & Legal Studies: 0964663912474862.

Critical Disability Studies:

  1. McRuer, R., & Wilkerson, A. L. (Eds.). (2003). Desiring disability: Queer theory meets disability studies. Duke University Press.
  2. Cheslack-Postava, Keely, and Rebecca M. Jordan-Young. 2012. Autism spectrum disorders: toward a gendered embodiment model. Social science & medicine 74(11): 1667-1674.
  3. Jack, Jordynn. 2011. The Extreme Male Brain? Incrementum and the Rhetorical Gendering of Autism. Disability Studies Quarterly 31(3). http://dsq-sds.org/article/view/1672/1599
  4. Garland-Thomson, R. (2005). Feminist disability studies. Signs: Journal of Women in Culture and Society30(2), 1557-1587.
  5. Shakespeare, T. (2006). The social model of disability. The disability studies reader2, 197-204.
  6. Breckenridge, C. A., & Vogler, C. A. (2001). The critical limits of embodiment: Disability’s criticism. Public Culture13(3), 349-357.

Masculinity & health:

  1. MacLeish, Kenneth T. 2012. Armor and anesthesia: exposure, feeling, and the soldier’s body. Medical anthropology quarterly 26(1): 49-68.
  2. Oudshoorn, Nelly. 2000. “Imagined men: Representations of masculinities in discourses on male contraceptive technology.” In Bodies of technology: Women’s involvement with reproductive medicine, edited by Ann Rudinow Saetnan, Nelly Oudshoorn, and Marta Kirejczyk. Columbus: Ohio State University Press, 123-45.
  3. Serlin, David. 2006. “Disability, masculinity, and the prosthetics of war, 1945 to 2005.” In The prosthetic impulse: From a posthuman present to a biocultural future, edited by Marquard Smith and Joanne Mora. Cambridge: The MIT Press, 155-86.
  4. Shakespeare, T. (1999). The sexual politics of disabled masculinity. Sexuality and disability17(1), 53-64.

Gender theory, race, and reproductive health:

  1. Waggoner, Miranda R. 2015. Cultivating the maternal future: Public health and the prepregnant self.” Signs 40(4): 939-962.
  2. Franklin, Sarah. 2013. Biological Relatives: IVF, Stem Cells, and the Future of Kinship. Durham: Duke University Press. (“Miracle Babies” and “Reproductive Technologies,” pp. 31 – 67 and 150 – 84).
  3. Murphy, M. (2012). Seizing the means of reproduction: Entanglements of feminism, health, and technoscience. Duke University Press.
  4. Roberts, Dorothy E. Killing the black body: Race, reproduction, and the meaning of liberty. Vintage Books, 1999.
  5. Bridges, Khiara. 2011. Reproducing race: An ethnography of pregnancy as a site of racialization. Berkeley: The University of California Press. (“The Production of Unruly Bodies” and “The ‘primitive pelvis,’ racial folklore, and atavism in contemporary forms of medical disenfranchisement,” pp. 74 – 100 and 103-43).

A Multi-Level Analysis of Barriers to Care: Macro Level (Structural)

I argued in a previous post that public health should look at factors impacting health using a multi-level approach. In this post, I attempt to outline the various multi-level barriers to medical care (specifically access to PrEP, HIV prevention, and AIDS care) for black queer men (or black men who have sex with men). This post focuses on structural barriers, but the micro and meso level analyses are also available.

At the structural level, queer men, especially those who are men of color, poor, disabled, or uneducated,  face stigma, low health literacy, discrimination, incarceration, poverty, and a general lack of access to healthcare all of which impact their ability to gain access to PrEP and other prevention measures and to continue their treatment and care (Levy et al., 2014; Philbin et al., 2016; Rucker et al., 2017; Thomann et al., 2017). Stigma continues to stand out as a huge structural barrier, especially with respect to access to PrEP or anything related to HIV or sexual health. HIV can often still be considered a “gay men’s disease” or something that only slut and whores have to worry about; these notions continue even from the medical institution, which also continues to emphasize the idea of “Truvada Whores”—the idea that queer men take PrEP in order to participate in riskier sexual behaviors rather than to decrease their risk of contracting HIV (Calabrese et al., 2017; Calabrese & Underhill, 2015). Some providers and researchers have gone so far as to recommend PrEP for everyone; however, we must remember to target PrEP to individuals who are at risk of contracting the disease rather than encouraging everyone to take it even if they are incredibly unlikely to contact HIV (Calabrese, Underhill, et al., 2016). Of course, there are heterosexual individuals who are at risk of contracting HIV, who should likely be taking PrEP, though it has primarily been targeted towards gay men (in sometimes insensitive advertisements that increase stigma for the queer community), but there are also people who don’t have enough risk factors to warrant the medication.

Calabrese, S. K., Magnus, M., Mayer, K. H., Krakower, D. S., Eldahan, A. I., Hawkins, L. A. G., . . . Dovidio, J. F. (2017). “Support Your Client at the Space That They’re in”: HIV Pre-Exposure Prophylaxis (PrEP) Prescribers’ Perspectives on PrEP-Related Risk Compensation. AIDS Patient Care STDS, 31(4), 196-204. doi:10.1089/apc.2017.0002

Calabrese, S. K., & Underhill, K. (2015). How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores”. Am J Public Health, 105(10), 1960-1964. doi:10.2105/ajph.2015.302816

Calabrese, S. K., Underhill, K., Earnshaw, V. A., Hansen, N. B., Kershaw, T. S., Magnus, M., . . . Dovidio, J. F. (2016). Framing HIV Pre-Exposure Prophylaxis (PrEP) for the General Public: How Inclusive Messaging May Prevent Prejudice from Diminishing Public Support. AIDS Behav, 20(7), 1499-1513. doi:10.1007/s10461-016-1318-9

Levy, M. E., Wilton, L., Phillips, G., Glick, S. N., Kuo, I., Brewer, R. A., . . . Magnus, M. (2014). Understanding Structural Barriers to Accessing HIV Testing and Prevention Services Among Black Men Who Have Sex with Men (BMSM) in the United States. AIDS Behav, 18(5), 972-996. doi:10.1007/s10461-014-0719-x

Philbin, M. M., Parker, C. M., Parker, R. G., Wilson, P. A., Garcia, J., & Hirsch, J. S. (2016). The Promise of Pre-Exposure Prophylaxis for Black Men Who Have Sex with Men: An Ecological Approach to Attitudes, Beliefs, and Barriers. AIDS Patient Care and STDs, 30(6), 282-290. doi:10.1089/apc.2016.0037

Rucker, A. J., Murray, A., Gaul, Z., Sutton, M. Y., & Wilson, P. A. (2017). The role of patient-provider sexual health communication in understanding the uptake of HIV prevention services among Black men who have sex with men. Cult Health Sex, 1-11. doi:10.1080/13691058.2017.1375156

Thomann, M., Grosso, A., Zapata, R., & Chiasson, M. A. (2017). ‘WTF is PrEP?’: attitudes towards pre-exposure prophylaxis among men who have sex with men and transgender women in New York City. Cult Health Sex, 1-15. doi:10.1080/13691058.2017.1380230

A Multi-Level Analysis of Barriers to Care: Meso Level (Interactional & Community)

I argued in a previous post that public health should look at factors impacting health using a multi-level approach. In this post, I attempt to outline the various multi-level barriers to medical care (specifically access to PrEP, HIV prevention, and AIDS care) for black queer men (or black men who have sex with men). This post focuses on the meso or mid-range level of analysis, and an analysis of the micro level is available from last week.

Black queer men especially lack trust in the pharmaceutical industry as well as in providers and the medical institution themselves (Philbin et al., 2016; Rucker et al., 2017; Thomann et al., 2017). This moves into a community level and interactional level issue where the community has many reasons not to trust providers or drug companies. We can think back to previous studies like the Tuskegee experiments, but we can also think about the lack of adequate care for black patients currently, including limited pain management and less patient-centeredness to name a few examples (Hoffman, Trawalter, Axt, & Oliver, 2016). This is a considerable barrier for providers to overcome in order to provide better treatment to black queer men. Similarly, queer men generally face implicit and explicit bias from providers and receive worse care, and this lack of care is exacerbated by other marginalized social positions (Phelan et al, 2014).

These could also be seen as macro level issues at the institutional level because the medical institution and pharmaceutical industry have constructed a practice that is ineffective for many marginalized individuals. Further, this stems from structural issues in our country such as racism, incarceration, and stigma that limit access to health care and impact our institutions.

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A, 113(16), 4296-4301. doi:10.1073/pnas.1516047113

Philbin, M. M., Parker, C. M., Parker, R. G., Wilson, P. A., Garcia, J., & Hirsch, J. S. (2016). The Promise of Pre-Exposure Prophylaxis for Black Men Who Have Sex with Men: An Ecological Approach to Attitudes, Beliefs, and Barriers. AIDS Patient Care and STDs, 30(6), 282-290. doi:10.1089/apc.2016.0037

Rucker, A. J., Murray, A., Gaul, Z., Sutton, M. Y., & Wilson, P. A. (2017). The role of patient-provider sexual health communication in understanding the uptake of HIV prevention services among Black men who have sex with men. Cult Health Sex, 1-11. doi:10.1080/13691058.2017.1375156

Thomann, M., Grosso, A., Zapata, R., & Chiasson, M. A. (2017). ‘WTF is PrEP?’: attitudes towards pre-exposure prophylaxis among men who have sex with men and transgender women in New York City. Cult Health Sex, 1-15. doi:10.1080/13691058.2017.1380230

 

A Multi-Level Analysis of Barriers to Care: Micro Level (Individual)

I argued in a previous post that public health should look at factors impacting health using a multi-level approach. In this post, I attempt to outline the various multi-level barriers to medical care (specifically access to PrEP, HIV prevention, and AIDS care) for black queer men (or black men who have sex with men).

At the individual level (the micro level), queer men are skeptical of medication for healthy individuals and wary of the potential side effects caused by these medications (Philbin et al., 2016). These ideas seem to go hand-in-hand. If you don’t want to take medication as a healthy person, you’d be worried about the potential side effects that would ultimately make a health person sick in order to prevent something that you might or might not contract. In this sense, it might be important to make people recognize the real possibility of contract the disease. We’re treating risk here, but preventing the disease is important. Further, the side effects of PrEP are fairly uncommon.

Queer men might think that this medication would be useful for others but not for them. Here, we have to think about assessing the individual patient to decide whether or not PrEP is right for them (Philbin et al., 2016). We’re not treating someone because they’re black and queer, and black queer men have the highest rates of HIV. It’s obviously possible for black queer men to have low associated risk of HIV. Treating high risk means treating patients with high risk factors not treating everyone from a population that has high rates of the disease. However, this presents an added barrier for providers to convince patients with high risks that this is the right drug for them.

Philbin, M. M., Parker, C. M., Parker, R. G., Wilson, P. A., Garcia, J., & Hirsch, J. S. (2016). The Promise of Pre-Exposure Prophylaxis for Black Men Who Have Sex with Men: An Ecological Approach to Attitudes, Beliefs, and Barriers. AIDS Patient Care and STDs, 30(6), 282-290. doi:10.1089/apc.2016.0037

 

 

Multi-level Models of Health Behavior for HIV

In a post about public health and epistemologies of ignorance, I argued that public health interventions have focused solely on the individual rather than looking at other factors impacting health. Moving forward, we need to develop multi-level models of health behavior, so here are a few examples of a multi-level analysis and multi-level models related to HIV prevention and AIDS care. Kaufman et al (2014) present a multi-level analysis of factors impacting HIV-related behavior and behavior change and review a few recent models for looking at HIV-related health behavior from multiple levels. The transtheoretical and health belief models and the theories of reasoned action and planed behavior have been used repeatedly in public health literature about HIV-related health behaviors, but all of these models and theories focus on the individual rather than looking at the individual as part of a larger system.

Kaufman et al (2014) looked at four multi-level models that expand on the individual models of health behavior to look at a more holistic picture:

  1. The Multiple Domain Model: Zimmerman, R. S., Noar, S. M., Feist-Price, S., Dekthar, O., Cupp, P. K., Anderman, E., & Lock, S. (2007). Longitudinal test of a multiple domain model of adolescent condom use. Journal of Sex Research44(4), 380-394.
  2. The Network-Individual-Resource Model: Johnson, B. T., Redding, C. A., DiClemente, R. J., Mustanski, B. S., Dodge, B., Sheeran, P., … & Carey, M. P. (2010). A network-individual-resource model for HIV prevention. AIDS and Behavior14(2), 204-221.
  3. The Dynamic Social Systems Model: Latkin, C., Weeks, M. R., Glasman, L., Galletly, C., & Albarracin, D. (2010). A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS and Behavior14(2), 222-238.
  4. The Transmission Reduction Intervention Project: Friedman, S. R., Downing, M. J., Smyrnov, P., Nikolopoulos, G., Schneider, J. A., Livak, B., … & Psichogiou, M. (2014). Socially-integrated transdisciplinary HIV prevention. AIDS and Behavior18(10), 1821-1834.

These are just a few examples of models that look at factors on multiple levels, specifically for HIV. More work should be done to expand and perfect these models, though the move towards multi-level models is certainly a move in the right direction. We should attempt to use a social-ecological framework with thinking about other public health interventions as well.

Kaufman, M. R., Cornish, F., Zimmerman, R. S., & Johnson, B. T. (2014). Health Behavior Change Models for HIV Prevention and AIDS Care: Practical Recommendations for a Multi-Level Approach. Journal of Acquired Immune Deficiency Syndromes (1999)66(Suppl 3), S250–S258. http://doi.org/10.1097/QAI.0000000000000236

Implicit Bias in Prescription of PrEP

African American men who have sex with men (MSM) are disproportionately affected by HIV; however, recent research suggests that medical providers are less likely to prescribe Pre-Exposure Prophylaxis (PrEP), a preventative treatment for HIV, to black MSM (Calebrese et al, 2014). This is a direct result of implicit racial bias, prejudice, and a lack of institutional knowledge on the part of medical providers. Current stereotypes about gay men exist among many medical practitioners, specifically with regard to “Truvada Whores.” It is assumed that MSM who take PrEP will participate in more risky behaviors and thus be at greater risk of HIV, though PrEP is an important measure for reducing risk of HIV. This is further exacerbated by implicit racial bias which corroborates beliefs by providers that black MSM are even more likely than white MSM to partake in risky sexual behaviors if they are prescribed PrEP. As such, medical providers are less likely to prescribe PrEP to black MSM, barring them from access to an important and potentially life-saving measure to prevent HIV, a disease that they are disproportionately affected by.

This research suggests that public health interventions that focus on black MSM might be misplacing their efforts by focusing on changing the behaviors of the individuals or encouraging use of PrEP if they don’t have the necessary support from their doctors. Perhaps, public health interventions should focus on developing additional institutional knowledge to prepare medical providers for caring for black MSM and providing adequate sexual health care.

Calabrese, S. K., Earnshaw, V. A., Underhill, K., Hansen, N. B., & Dovidio, J. F. (2014). The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS Behav, 18(2), 226-240. doi:10.1007/s10461-013-0675-x

Coffee… Good or Bad for Health?

I recently read an article that was published a few days ago in The BMJ regarding coffee consumption and health. I was curious to learn what the findings were, considering that I have heard mixed reviews over the years about the health benefits of coffee.

After conducting an umbrella review of over 200 meta-analyses regarding coffee consumption and health outcomes, Poole et al. (2017) found that drinking three to four cups of coffee a day was associated with lower risk of a variety of health outcomes. According to the article, researchers found that drinking three cups of coffee a day lowered risk for death and cardiovascular disease, compared to non-coffee drinkers. Coffee consumption was also found to lower risk of various cancers, as well as neurological, liver, and metabolic diseases. In women who are pregnant, however, high levels of coffee consumption were associated with higher risk of low birth weight, pregnancy loss, as well as preterm births. Additionally, coffee consumption was found to be associated with an increased risk of fracture in women.

A note that this study mentions is that current evidence on the topic of coffee consumption and health is mainly observational and of lower quality in nature. That said, researchers recommend that randomized controlled trials be used in future research to better understand causal associations between coffee consumption and various health outcomes.

Eliseo Guallar, professor of epidemiology and medicine at the Johns Hopkins Bloomberg School of Public Health published an editorial in response to Poole et al. (2017). Dr. Guallar comments that while coffee drinking is generally safe, people should not start drinking coffee for health reasons. Dr. Guallar continues in stating that “some population subgroups may be at higher risk of adverse effects” of coffee consumption. Additionally, Dr. Guallar expressed the importance of the amount of coffee consumption, asserting that there remains uncertainty regarding the effects of higher levels of coffee consumption. However, Dr. Guallar expressed that moderate coffee consumption is safe and can be a part of a healthy diet.

References:

Poole, R., Kennedy, O.J., Roderick, P., Fallowfield, J.A., Hayes, P.C., & Parkes, J. (2017). Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes. BMJ 2017; 359:j5024. doi: https://doi.org/10.1136/bmj.j5356 

Guallar, E. (2017). Coffee gets a clean bill of health. BMJ 2017; 359:j5356. doi: https://doi.org/10.1136/bmj.j5356