Stigma and patient work: the challenges of accessing healthcare and HIV services amongst young and geographically diverse gay and bisexual men in New South Wales
Bibliographic record
Abstract
Background: Amongst gay and bisexual men (GBM), new HIV notifications have declined in NSW over the last decade, but declines have not been evenly distributed. Young GBM and GBM outside inner-Sydney are priority populations in the NSW HIV Strategy 20212025, which recognises that stigma reduces access to HIV prevention, testing and treatment. We conducted a qualitative study to investigate experiences of stigma and healthcare access amongst these priority populations. Methods: In 2023, 32 GBM participated in semi-structured interviews. Almost all participants were cisgender men, most were gay (n=25), and others a mix of bi+ or queer. 14 were young (18-25 years); 16 lived in regional NSW, and 11 in Greater Western Sydney. Additionally, 5 were living with HIV; and 7 currently using PrEP. Data were analysed thematically, drawing on the concept of ‘patient work’, which describes the forms of labour that people undertake to engage with healthcare. Results: Our analysis identified various forms of patient work undertaken to manage anticipated stigma and disclosure of sexual orientation or HIV status in healthcare. Participants looked for cues from clinicians that disclosure would be safe and respected, such as clinicians asking open-ended questions about partners and sexual practices. Some reported instances of GPs refusing to provide PrEP prescribing, mostly occurring in Greater Western Sydney. To avoid stigma, some reported travelling further distances to services predicted to be safe and competent. Overall, participant accounts indicate that significant patient work is undertaken to access services and prevent stigma, exacerbated by fewer publicly funded and nonjudgemental services in some suburbs and regions. Conclusion: Although experiences of reported stigma in healthcare were low in this sample, anticipated stigma impacted decisions that GBM made about accessing healthcare. Focusing on patient work illuminates the labour that GBM engage in to access HIV and healthcare services, suggesting areas of unmet need in healthcare services.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".