Can We Stop the Doctor Bias Against Queer Black Men?

If you’re a gay black man living with HIV in America, finding a quality doctor is difficult. Racial bias lingers under the radar whether we see it or not, but thankfully one organization is hoping to put a stop to it — one click at a time. 

The National Alliance of State and Territorial AIDS Directors is launching a new online training platform, HisHealth.org, to help doctors, nurses, and other medical professionals unlearn racial bias and elevate the quality of healthcare for African-American men who have sex with men. And the timing couldn’t be better.

In a world where only one in three doctors know what PrEP is, the quality of healthcare for LGBTQ people is clearly low due to a lack of education and training. This ignorance is just one more reason half of Black gay men will test positive for HIV in their lifetimes, according to the Centers for Disease Control and Prevention.

Those already living with HIV also face healthcare barriers, Omoro F. Omoighe, an associate director with NASTAD, tells Plus. “For some young Black gay men who are new to healthcare and grappling with a new HIV diagnosis, it may be challenging to speak up and advocate for themselves and say ‘I actually don’t quite understand what you mean by viral load’ or ‘I don’t quite understand the treatment that you are recommending.’ Healthcare providers need be aware of these fears and knowledgeable about what Black gay men are going through so they can better address their healthcare needs.”  

Led primarily by physicians who are African-American gay men themselves, HisHealth.org will provide accredited and expert-led continuing education courses that count towards the credits medical professionals need to maintain their licenses. It will explore various models of care, including Project Silk and Connecting Resources for Urban Sexual Health. It will also provide easy access to resources that support the delivery of high quality, culturally affirming healthcare services for Black gay and bisexual men.

HisHealth.org offers hour-long, self-paced modules covering topics like PrEP, linkage to care, whole health assessments, and transgender health.

“Many patients talk about having to educate their healthcare provider about their sexual health needs,” Omoighe explains, “If a patient is educating their doctor about their sexual preferences and behaviors, the provider is learning in real time," which makes it hard for the doctor to provide quality advice.  Omoighe believes doctors will find that going the extra mile pays off in the end. "Minding the communication gap and being comfortable working with patients who love and live differently than you do is going to be completely transformative with regard to the quality of care that is offered to these patient communities.”

As Plus reported previously, less than ten percent of gay and bi men have used PrEP before, and outreach often skips lower economic neighborhoods. Why?

“Research shows that implicit bias stops many doctors from providing high-quality care to Black Americans,” Terrance Moore, Deputy Executive Director at NASTAD, said in a statement to the press. “Add to that a lack of understanding about the sexual healthcare needs of LGBT patients — and many men I know would rather stay home. That’s why this new tool is so important — we can help doctors fight implicit bias and provide better care.”

A 2014 study by the Perception Institute found evidence that bias is a pervasive issue within the medical field. Researchers discovered that non-Black doctors often treat pain less aggressively for their African-American patients. Earlier this year, a study by a Yale researcher suggested that non-Black doctors were also less engaged with their Black patients. Add to that many healthcare providers' hesitance in starting frank discussions about sexual specifics — particularly those involving anal sex — and Black gay and bi men are doubly disadvantaged.  

“For many Black gay men, their care experiences are marred by a palatable sense of uneasiness and discomfort that some doctors and nurses have discussing their preferred sexual practices, desires, and behaviors,” Omoighe says. “The confluence of these factors can translate into subpar healthcare and increased risk for HIV transmission. If your doctor is uncomfortable and or unfamiliar with your sexual health needs, they will be unable to offer their patients adequate preventative care. HisHealth.org is the first step towards addressing this critical communication gap.”

It’s time for doctors to get comfortable with being uncomfortable. America’s response to the HIV epidemic among gay and bi men of color needs to improve. HisHealth aims to address the problem while elevating the standard of healthcare for queer Black men. Raising the bar, and helping doctors become more culturally competent, actually benefits us all.