A qualitative exploration of the client-provider relationship and its role in discussing sexual health and HIV among African American women in the US South

Rachel Vanderkruik; Georgia R Goodman; Abigail Blyler; Corilyn Ott; Alexa Rivas; Latesha Elopre; Doug Krakower; Kachina Kudroff; Jenni Wise; Eric Underwood; Victoria McDonald; Marquetta Campbell; Mirjam-Colette Kempf; Christina Psaros

doi:10.1016/j.srhc.2024.101043

A qualitative exploration of the client-provider relationship and its role in discussing sexual health and HIV among African American women in the US South

Sex Reprod Healthc. 2024 Nov 5:42:101043. doi: 10.1016/j.srhc.2024.101043. Online ahead of print.

Authors

Affiliations

¹ Department of Psychiatry, Massachusetts General Hospital, Boston MA, United States.
² Department of Psychiatry, Massachusetts General Hospital, Boston MA, United States; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States; The Fenway Institute, Fenway Health, Boston, MA, United States.
³ Positive Psychology Center, University of Pennsylvania, Philadelphia, PA, United States.
⁴ School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States; School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
⁵ School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
⁶ The Fenway Institute, Fenway Health, Boston, MA, United States; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
⁷ Whatley Health Services, Inc., Maude L. Whatley Health Center, Tuscaloosa, AL, United States.
⁸ School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States.
⁹ School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States; School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States; School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States.
¹⁰ Department of Psychiatry, Massachusetts General Hospital, Boston MA, United States. Electronic address: cpsaros@mgh.harvard.edu.

PMID: 39546962
DOI: 10.1016/j.srhc.2024.101043

Abstract

Objective: Sexually transmitted infections (STIs), including HIV, are a key contributor to psychological and physical morbidity across the United States (US). African American (AA) women are disproportionately impacted by STIs, particularly in the Deep South of the US. Strong patient-provider communication can help to increase client understanding of STI prevention and treatment options. This study aimed to explore factors influencing effective patient-provider relationships and communication around STIs (including HIV) and sexual health broadly, which will ultimately inform the refinement of a patient-provider communication tool for discussing PrEP as an HIV prevention method.

Methods: As part of a larger study focused on PrEP implementation, in-depth, semi-structured qualitative interviews were conducted among cisgender AA women who are PrEP-eligible, both with and without PrEP experience, as well as providers from three federally qualified health centers (FQHCs) and HIV service agencies in Alabama. Data were analyzed using content analysis.

Results: A total of 41 participants enrolled, including 21 clients (n = 6 PrEP experienced; n = 15 PrEP naïve) and 20 providers. Qualitative data were organized across the following domains: meaning of health and sexual health, factors influencing the client-provider relationship, and factors influencing sexual health discussions among clients and providers. Key factors influencing client-provider relationships were organized at client, provider, and clinic levels. Factors impacting sexual health discussions between clients and providers were organized at client, provider, and structural levels.

Conclusion: These interviews identified key determinants of effective client-provider communication pertaining to sexual health among cisgender AA women in the US South who were receiving care at FQHCs and HIV service organizations. Individual, provider, and clinic-level factors were identified that have implications for designing sexual health interventions for cisgender AA women.

Keywords: Health communication; Qualitative research; STIs; Sexual health.