Abstract

Shared decision making is a collaborative process intended to develop a treatment plan that considers both the patient’s preferences and the health provider’s medical recommendations. It is one approach to reducing healthcare disparities by improving patient-provider communication and subsequent health outcomes. This study examines shared decision making about HIV pre-exposure prophylaxis (PrEP) with Black transgender women in Chicago, Illinois, USA, given high prevalence of HIV and disparities in PrEP use. Black transgender women were recruited online and in-person to participate in semi-structured interviews (n = 24) and focus groups (2; n = 14 total), conducted between 2016 and 2017. Iterative thematic content analysis took place. Analysis revealed that internalised transphobia and racism, combined with stigma from service providers, prevented disclosure of gender and sexual identity to providers. Stigma about PrEP as it relates to Black transgender women results in stereotype threat, which undermines patient-provider trust and deters shared decision making for PrEP. Shared decision making promotes cultural competence and humility and builds trust within the patient-provider relationship, leading to better communication and less stigma. The involvement of peers may be one way to mitigate stigma for Black transgender women around PrEP, promote cultural competence within organisations, and empower engagement in shared decision making for HIV prevention.

摘要

共同决策是一个协作过程，旨在制定一个考虑患者偏好和医疗服务提供者医疗建议的治疗计划。这是通过改善患者与提供者的沟通和随后的健康结果来减少医疗保健差异的一种方法。鉴于 HIV 的高流行率和 PrEP 的使用差异，本研究考察了美国伊利诺伊州芝加哥市与黑人跨性别女性在 HIV 暴露前预防 (PrEP) 方面的共同决策。在线和亲自招募黑人跨性别女性参加半结构化访谈（n  = 24）和焦点小组（2；n = 共 14 个），在 2016 年至 2017 年期间进行。进行了迭代主题内容分析。分析表明，内化的跨性别恐惧症和种族主义，再加上服务提供者的污名化，阻止了向提供者披露性别和性身份。与黑人跨性别女性相关的 PrEP 污名化会导致刻板印象威胁，这会破坏患者与提供者之间的信任并阻碍 PrEP 的共同决策。共同决策促进了文化能力和谦逊，并在患者与提供者关系中建立信任，从而改善沟通并减少耻辱感。同龄人的参与可能是减轻黑人跨性别女性对 PrEP 的污名、提高组织内的文化能力以及增强参与艾滋病预防共同决策的一种方式。