Stigma and patient work
Understanding cumulative inequities for gay and bisexual men in accessing HIV healthcare services
Bibliographic Data
| ID | 5149368 |
|---|---|
| Authors | A K Smith (0000-0002-0005-9542, Australian Human Rights Commission), L Brener (0000-0002-7453-4852, UNSW Sydney), Timothy R Broady (0000-0002-4341-1868, UNSW Sydney), Bernard Saliba (0000-0001-8752-4242, UNSW Sydney), Paul Keen (0000-0002-2678-0645, UNSW Sydney), Bianca Prain (New South Wales Department of Health), Carla Treloar (0000-0002-8230-0386, UNSW Sydney) |
| Year | 2025 |
| Volume | 367 |
| Pages | 117729 |
| Publication date | 2025-02-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Social Science & Medicine (JOURNAL) |
| Journal identifiers | ISSN: 0277-9536 • E-ISSN: 1873-5347 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.socscimed.2025.117729 |
| PMID | 39889381 |
| OpenAlex | W4406683003 |
| Language | EN |
| Citations received | 8 |
| References cited | 30 |
Patient work refers to the quotidian labour undertaken by individuals to manage health, often unrecognised by health systems. This article argues that anticipated and received stigma and inclusivity labour comprise additional forms of patient work specific to minority populations. We draw on a case study of gay and bisexual men's experiences accessing healthcare services related to HIV prevention and testing in New South Wales (NSW), Australia's most populous state. Although new HIV diagnoses have reduced in NSW, these declines have not been uniformly observed. This study aimed to understand experiences of stigma related to accessing healthcare amongst two priority populations identified in the state's HIV strategy: gay and bisexual men who are young or who are living in regional and outer metropolitan suburbs. We interviewed 32 participants in 2023, recruited via social media advertisements and email invitations, and analysed data thematically. Our findings emphasise how disclosure of sexual orientation and/or HIV status operates as a form of inclusivity labour, in which patients look for cues from health providers that disclosure will be safe and respected. Other forms of patient work required to navigate access to HIV prevention services included finding appropriate providers likely to prescribe HIV pre-exposure prophylaxis (PrEP) and managing service refusal from general practitioners. Patient work appeared to also be compounded by intersecting issues of anticipated and vicarious stigma, unavailability of sexual health services in regional areas, long waiting times, and increased costs of healthcare services. Although experiences of enacted stigma in healthcare were infrequently reported, interview accounts suggested that participants undertook extensive patient work to minimise or avoid stigmatising encounters with health providers. Focusing on patient work in the context of stigma illuminates the labour of underserved populations required to access safe and culturally competent healthcare services (including HIV prevention and testing), suggesting areas of unmet need from health systems
Family medicine · Health care · Homosexuality · Human immunodeficiency virus (HIV · Political science · Psychiatry · Sociology · Stigma (botany · Gender Studies · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · LGBTQ Health, Identity, and Policy · Medicine · Psychology
Experiences of Living with HIV, Stigma, and Healthcare Access in Australia among People Born in China, Thailand, and Latin America Compared to People Born in Australia
Caring infrastructures for sexual health and the implications of antibiotic-resistant STIs
Sexual Orientation, Gender, and HIV-Related Stigma or Discrimination Among Gay and Bisexual Men and Non-Binary People in Australia
“The Culturally and Linguistically Diverse Community Is Not Just Minoritised But Ignored”
Selective disclosure and different levels of support
Managing collateral stigmatization while accessing biomedical HIV prevention for queer people in Dar es Salaam
A Decade of HIV Pre-Exposure Prophylaxis (PrEP) Cascade Monitoring
Talking to the GP
The Health Stigma and Discrimination Framework
Effectiveness and safety of oral HIV preexposure prophylaxis for all populations
Stigma
Thematic Analysis
The impact of sources of stigma on health care avoidance among gay and bisexual men in Australia
Variations in HIV Prevention Coverage in Subpopulations of Australian Gay and Bisexual Men, 2017–2021
Inclusive health care for LGBTQ+ youth
Experiences of, and motivations for, disclosing HIV to social and familial networks
A qualitative exploration of the impact of the marriage equality debate on same‐sex attracted Australians and their allies
Stigma consciousness
Concealable Stigmatized Identities and Psychological Well‐Being
Managing Stigma
The use of PrEP among men who have sex with men and transgender women as Biomedical Prevention Work
From silence to sensitivity
HIV-related stigma
Managing chronic illness at home
The Stigma Complex
Making Assumptions, Making Space
Dosing practices made mundane
Family imaginaries in the disclosure of a blood-borne virus
| Unique citing works | 8 |
|---|---|
| Citations per year | 8 |
| Citation span | 2025 - 2026 (2) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 7 |