When Provider Contact Does Not Become PrEP Care

Area of Science:

• Public Health
• Health Communication
• Social Sciences

Background:

• Pre-exposure prophylaxis (PrEP) uptake is inequitable across racial, gender identity, and socioeconomic lines within sexual and gender minority (SGM) populations.
• Existing disparities persist despite awareness and provider discussions, indicating a gap beyond initial contact.

Purpose of the Study:

• To conceptualize PrEP disparities as communication inequality within clinical encounters.
• To analyze how provider contact translates into actionable PrEP care, focusing on conversion endpoints.

Main Methods:

• Utilizes Lin's network theory of social capital to frame provider contact as a mobilization event.
• Introduces the concept of a 'return deficit' to explain unequal outcomes from similar clinical resources.
• Examines intersectional discrimination's role via patient disclosure costs and provider recognition failures.

Main Results:

• Formally similar provider contacts yield unequal PrEP care outcomes across different SGM subgroups.
• Intersectional discrimination creates barriers, including patient disclosure costs and provider failure to recognize PrEP candidacy.
• The disparity lies not in the occurrence of provider discussion but in its failure to convert into effective care.

Conclusions:

• PrEP disparities among SGM populations are rooted in communication inequality at the clinical encounter.
• Interventions should focus on improving the conversion of provider contact into actionable PrEP care, addressing recognition failures and disclosure costs.
• Understanding the 'return deficit' is crucial for addressing intersectional inequities in PrEP access.