Trust in physicians among young sexual minority men

Trust in physicians and the medical establishment more broadly is critical for access to and provision of relevant healthcare services. This is especially true for sexual minority men (SMM) as their healthcare is negatively impacted due to stigma and discrimination which in turn affects disclosure of sexual behavior and sexual orientation. This study sought to understand trust in physicians (TIP) as it relates to anal sex position, difficulty in paying for healthcare, insurance status, and pre-exposure prophylaxis (PrEP) use. This study employs data from a cross-sectional survey conducted between February 2018 and February 2019. The final analytic sample is 179 sexual minority men who reported an human immunodeficiency virus (HIV) negative serostatus and identified as a sexual minority person (i.e., non-heterosexual). The present use of the Trust in Physicians Scale is further dichotomized for analytical purposes. The results show that slightly over half of the participants (52%, n = 93) reported trusting their physicians. Higher trust in physician scores were associated with preference of anal sex position (insertive or receptive as opposed to versatile/no preference), less difficulty in paying for health care services, people who were uninsured, and those who were currently using PrEP. In conclusion, TIP plays a critical role in disclosure of sexual orientation and sexual behaviors that allow for the delivery of necessary and appropriate healthcare services. Findings from this study can be used to develop best practices for taking patient histories that foster trust and disclosure of sensitive health information.

Sexual minority men; Trust in physicians; PrEP; Healthcare

[1] Huynh HP, Dicke-Bohmann A. Humble doctors, healthy patients? Exploring the relationships between clinician humility and patient satisfaction, trust, and health status. Patient Education and Counseling. 2020; 103: 173–179.

[2] Berger R, Bulmash B, Drori N, Ben-Assuli O, Herstein R. The patient-physician relationship: an account of the physician’s perspective. Israel Journal of Health Policy Research. 2020; 9: 33.

[3] Nguyen AL, Schwei RJ, Zhao YQ, Rathouz PJ, Jacobs EA. What matters when it comes to trust in one’s physician: race/ethnicity, sociodemographic factors, and/or access to and experiences with health care? Health Equity. 2020; 4: 280–289.

[4] Thom DH, Ribisl KM, Stewart AL, Luke DA. Further validation and reliability testing of the trust in physician scale. Medical Care. 1999; 37: 510–517.

[5] Senteio CR, Yoon DB. How primary care physicians elicit sensitive health information from patients: describing access to psychosocial information. Qualitative Health Research. 2020; 30: 1338–1348.

[6] Świątoniowska-Lonc N, Polański J, Tański W, Jankowska-Polańska B. Impact of satisfaction with physician-patient communication on self-care and adherence in patients with hypertension: cross-sectional study. BMC Health Services Research. 2020; 20: 1046.

[7] Fava GA, Cosci F, Sonino N, Guidi J. Understanding health attitudes and behavior. The American Journal of Medicine. 2023; 136: 252–259.

[8] Reschovsky JD, Kemper P, Tu H. Does type of health insurance affect health care use and assessments of care among the privately insured? Health Services Research. 2000; 35: 219–237.

[9] Churchwell K, Elkind MS, Benjamin RM, Carson AP, Chang EK, Lawrence W, et al. Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American Heart Association. Circulation. 2020; 142: e454–e468.

[10] Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Reports. 2003; 118: 358–365.

[11] Crenshaw KW. Mapping the margins: intersectionality, identity politics, and violence against women of color. In Fineman MA (ed.) The public nature of private violence (pp. 93–118). 1st edn. Routledge: New York. 2013.

[12] Hsieh N, Ruther M. Despite increased insurance coverage, nonwhite sexual minorities still experience disparities in access to care. Health Affairs. 2017; 36: 1786–1794.

[13] McWilliams JM. Health consequences of uninsurance among adults in the United States: recent evidence and implications. The Milbank Quarterly. 2009; 87: 443–494.

[14] Dahlhamer JM, Galinsky AM, Joestl SS, Ward BW. Barriers to health care among adults identifying as sexual minorities: a US national study. American Journal of Public Health. 2016; 106: 1116–1122.

[15] Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the United States. JAMA. 2000; 284: 2061–2069.

[16] Jaiswal J, Halkitis PN. Towards a more inclusive and dynamic understanding of medical mistrust informed by science. Behavioral Medicine. 2019; 45: 79–85.

[17] Shangani S, Naanyu V, Operario D, Genberg B. Stigma and healthcare-seeking practices of men who have sex with men in Western Kenya: a mixed-methods approach for scale validation. AIDS patient care and STDs. 2018; 32: 477–486.

[18] Jaiswal J, Griffin M, Singer SN, Greene RE, Acosta IL, Kaudeyr SK, et al. Structural barriers to pre-exposure prophylaxis use among young sexual minority men: the P18 cohort study. Current HIV Research. 2018; 16: 237–249.

[19] Calabrese SK, Rao S, Eldahan AI, Tekeste M, Modrakovic D, Dangaran D, et al. “Let’s be a person to person and have a genuine conversation”: comparing perspectives on PrEP and Sexual health communication between black sexual minority men and healthcare providers. Archives of Sexual Behavior. 2022; 51: 2583–2601.

[20] Goparaju L, Praschan NC, Warren-Jeanpiere L, Experton LS, Young MA, Kassaye S. Stigma, partners, providers and costs: potential barriers to PrEP uptake among US women. Journal of AIDS Clinical Research & STDs. 2017; 8: 730.

[21] Kimball D, Rivera D, Gonzales M 4th, Blashill AJ. Medical mistrust and the PrEP cascade among Latino sexual minority men. AIDS and Behavior. 2020; 24: 3456–3461.

[22] Pregnall AM, Churchwell AL, Ehrenfeld JM. A call for LGBTQ content in graduate medical education program requirements. Academic Medicine. 2021; 96: 828–835.

[23] Quinn K, Dickson-Gomez J, Zarwell M, Pearson B, Lewis M. “A gay man and a doctor are just like, a recipe for destruction”: how racism and homonegativity in healthcare settings influence PrEP uptake among young black MSM. AIDS and Behavior. 2019; 23: 1951–1963.

[24] Stults CB, Grov C, Anastos K, Kelvin EA, Patel VV. Characteristics associated with trust in and disclosure of sexual behavior to primary care providers among gay, bisexual, and other men who have sex with men in the United States. LGBT Health. 2020; 7: 208–213.

[25] Hascher K, Jaiswal J, Lorenzo J, LoSchiavo C, Burton W, Cox A, et al. ‘Why aren’t you on PrEP? You’re a gay man’: reification of HIV ‘risk’ influences perception and behaviour of young sexual minority men and medical providers. Culture, Health & Sexuality. 2023; 25: 63–77.

[26] Halkitis PN, Moeller RW, Siconolfi DE, Storholm ED, Solomon TM, Bub KL. Measurement model exploring a syndemic in emerging adult gay and bisexual men. AIDS and Behavior. 2013; 17: 662–673.

[27] Anderson LA, Dedrick RF. Development of the trust in physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychological Reports. 1990; 67: 1091–1100.

[28] Gopichandran V, Kalsingh M, Veliah G. Psychometric properties of the trust in physician scale in Tamil Nadu, India. Journal of Family Medicine and Primary Care. 2017; 6: 34–38.

[29] Griffin-Tomas M, Cahill S, Kapadia F, Halkitis PN. Access to health services among young adult gay men in New York City. American Journal of Men’S Health. 2019; 13: 1557988318818683.

[30] Griffin M, Jaiswal J, King D, Singer SN, Halkitis PN. Sexuality disclosure, trust, and satisfaction with primary care among urban young adult sexual minority men. The Journal for Nurse Practitioners. 2020; 16: 378–387.

[31] Schmid AT, Payam S. “I don’t want to have sex as a woman”: a qualitative study exploring sexuality and sexual practices of drag queens in Germany. Journal of Homosexuality. 2023; 70: 2180–2200.

[32] Nowaskie DZ, Sowinski JS. Primary care providers’ attitudes, practices, and knowledge in treating LGBTQ communities. Journal of Homosexuality. 2018; 66: 1927–1947.

[33] Chaudry A, Jackson A, Glied SA. Did the affordable care act reduce racial and ethnic disparities in health insurance coverage? Commonwealth Fund. 2019; 11.

[34] Griffin M, Cahill S, Kapadia F, Halkitis PN. Healthcare usage and satisfaction among young adult gay men in New York city. Sexual and Gender Diversity in Social Services. 2020; 32: 531–551.

[35] Braksmajer A, Fedor TM, Chen S, Corales R, Holt S, Valenti W, et al. Willingness to take PrEP for HIV prevention: the combined effects of race/ethnicity and provider trust. AIDS Education and Prevention. 2018; 30: 1–12.

[36] Devarajan S, Sales JM, Hunt M, Comeau DL. PrEP and sexual well-being: a qualitative study on PrEP, sexuality of MSM, and patient-provider relationships. AIDS Care. 2020; 32: 386–393.

[37] New York City Department of Health. Evaluating PrEP social marketing campaigns: NYC’s staysure. 2017. Available at: https://www.nyc.gov/assets/doh/downloads/pdf/dires/evaluating-prep-social-marketing-campaigns.pdf (Accessed: 09 June 2024).

[38] Katz E, Edelstein B, Turiano NA. Age as a moderator of health outcomes and trust in physicians. Journal of Aging and Health. 2023: 36: 308–319.