Gendered Social Institutions and Preventive Healthcare Seeking for Black Men Who Have Sex with Men: The Promise of Biomedical HIV Prevention.

Abstract

Research on gender and health, including research conducted among Black men who have sex with men (BMSM), has primarily focused on how gender norms and roles shape healthcare engagement. Here we advance that work by demonstrating how a broader theorization of gender, particularly one that moves beyond gender norms and performance to incorporate structures such as the healthcare system and the labor market, can facilitate an understanding of how gender affects preventive healthcare seeking among BMSM, particularly the uptake of pre-exposure prophylaxis (PrEP), a promising approach to alleviate HIV disparities. This article is based on a year-long ethnographic study conducted in New York City with BMSM (n = 31; three interviews each) and community stakeholders (n = 17). Two primary findings emerged: (1) the labor market systematically excluded the men in our sample, which limited their ability to access employer-sponsored healthcare. Such discrimination may promote overt demonstrations of masculinity that increase their HIV vulnerability and decrease healthcare seeking, and (2) healthcare systems are not structured to promote preventive healthcare for men, particularly BMSM. In fact, they constrained men's access to primary providers and were usually tailored to women. Applying a structural, gendered lens to men's health-in addition to the more frequently researched individual or interpersonal levels-provides insight into factors that affect healthcare seeking and HIV prevention for BMSM. These findings have implications for the design of policies and institutional reforms that could enhance the impact of PrEP among BMSM. Findings are also relevant to the management of chronic disease among men more broadly.