External Barriers to Medical Care

Money, acquiring insurance, perceived lack of confidentiality, and an impersonal medical system were themes related to common external barriers to healthcare:

“What I’ve realized is you have to have money. That’s been my goal, to get a job with insurance. Because if you don’t have insurance, it’s like you don’t exist.” (Manhattan, 29)

“You can’t afford to take that day’s pay off to see a doctor, sit in the office for three or four hours, and lose that pay.” (Buffalo, 35)

“You go into a health clinic, you went there Tuesday, you’re going back Friday to pick up a prescription, your file’s been sitting on the table for a whole week. So the cleaner’s done seen it, another doctor, little gossiping girl that’s on the phone done seen your file, and that’s what we’re dealing with when we go into these little clinics.” (Manhattan, 22)
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“And after you’ve gone from one person to another person to another person.. .you feel like an object as opposed to a patient or a person. It’s a demoralizing process, and it tends to go deep over a period of time.” (Atlanta, 35)

These barriers are the ones typically mentioned in accessing health services and were confirmed during the focus groups, with the addition of a medical system that treats patients as “just another number” (as one participant put it) and improperly handles confidential information. Here, external barriers are not only those that prevent one from geographically getting to a medical facility but also those within the institutions themselves that prevent efficient and quality care.

Internalized Barriers to Healthcare

While external barriers were present, internalized impediments to medical care access, communication, and adherence also emerged during the focus groups, rooted in distrust of the medical system, fear of the health risks of being both black and homosexual, and perceiving healthcare as synonymous with “bad news” or judgement and discrimination.

“I see doctors as opportunists. They’re like legal hustlers. Just legal drug dealers.” (Rochester, 21)

“The same way you look at your shoes [right with left] is how they [doctors] look at gays. Gays is AIDS. AIDS is a monkey. In the dark understanding of the virus, that’s where it came from— monkeys. And the monkeys represent what? Blacks.” (Brooklyn, 45)
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“We have a mistrust to begin with. I think when I first walk in the door, they’re going to give me a bunch of pills—I’m not a pill-taker. Or they’re gonna give me a shot—I don’t like needles. I come into the hospital with an attitude.” (Buffalo, 28)

“As being a young black male, if I would come and say something’s wrong with me, they [medical providers] would say, ‘Oh, look at this, you know, they probably just hip-hoppin’ and screwin’ down, and you know, smokin’ the blunts, and then he gonna come in here, talkin’ bout he sick.’ So it’s like I’m stereotyped already. And now, if you say you’re gay, everybody can get the picture of the feminine, gay brother. So I guess it can come to sexuality because they [medical providers] feel, ‘Oh, he must have been loose in the booty already.’” (Harlem, 19)

“When I was growing up, all I can remember about going to the hospital or going to the doctor was bad news—something terrible.” (Albany, 40)

“I think that since my involvement with men, my fear of doctors has just skyrocketed. I can’t just be ’sick’ anymore. I can’t just have a common cold. Everything has to be HIV” (Albany, 36)

Issues around distrust, racial and sexual orientation stigma, and fear of medical facilities can serve as barriers to accessing services and open communication, even when these institutions are geographically and financially within reach. For some, it was a natural extension of everyday life to not talk openly about homosexuality in the medical setting, and it was easier to simply access emergency rooms for medical care on an as-needed basis, which was viewed as a much more streamlined, efficient process than outpatient medicine:

“In school, you got peer pressure. Everything— a lot of it—revolves around sexuality. ‘Oh, he dress gay! Oh, he talk gay! Oh, he look gay!’ So when you go to the doctor, and he asks you, ‘Have you had sexual…’ ‘No!’ I mean, that’s just how you look at it, because this big oP thing about gayness, it’s just no. Just no, no, no.” (Harlem, 19)
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“I would rather go to the emergency room than go to my doctor’s office, because I know there I’m seeing the receptionist, the nurse, the doctor, and that’s all.” (Atlanta, 32)