Providing positive patient care for all
Approximately 1.1 million people in the United States were living with HIV at the end of 2015, according to the Centers for Disease Control and Prevention. Of those people, one in seven had no idea that they were infected. Gay and bisexual men account for 70 percent of new HIV infections in the United States. Additionally, new HIV infections among gay and bisexual black men remained stable at approximately 10,000 annually in recent years.
Christopher Watson, a doctoral student in TCSPP’s Organizational Leadership and Psychology degree program, is focusing on the latter group to develop and implement a training curriculum for healthcare providers. Watson has partnered with a company called Mandate to train 100 providers on cultural humility that is designed to identify personal level biases and privileges that impact patient care.
“When you look at HIV, you understand the disparities among communities of color, particularly when it comes to young, black, gay men,” Watson says. “This training will help providers who are focused on this population, which is not monolithic. A sufficient amount of training data could be helpful for providers to have better knowledge and sensitivity for this group.”
Why the focus is on the provider instead of the patient
While Watson will admit that in order to better treat gay and bisexual men—as with any other group—they have to be willing to show up to the doctors’ offices in the first place and be honest with their PCPs. However, the person who has the authority to create an open, honest relationship is arguable.
“If you ask providers who has the power, they’re going to say the patients because they already know their own backgrounds,” Watson says. “And if you ask the patient, they’re going to say the providers because of their academic training. So it’s already lopsided. But in order to have an effective relationship, there has to be communication where the provider has to truly empower the patient. That 30-plus minute conversation during a physical is an opportunity to build a rapport between the two and make him comfortable disclosing everything from recent vacations to risky behaviors.”
Having dealt with patients for more than 15 years as a researcher and a director of clinical services, Watson admits he’d be hard-pressed to be shocked by anything a patient could say. But even as someone who has been desensitized by “the full gamut,” he is adamant about treating each patient individually as opposed to lumping them into a group.
“If we can shift the healthcare system or design it in a way that addresses the uniqueness of all of us, regardless of what that person brings to the table, that eliminates client-centered fear,” Watson says. “Let’s say I’m a married mother of two children. Being married doesn’t necessarily mean a person is not at risk. Who knows what she does when her husband isn’t around? Or, what if the husband is deployed? Providers cannot just assume because a client has a specific label that that captures the truthfulness of the person in front of them. They have to be willing to build the kind of rapport to help the patient want to be honest with them.”
“I don’t want to put 100 percent of the blame on providers,” Watson continues. “But I believe there are some mental health factors that we need to get through to make more patients even want to go see their doctors. Are there barriers? Will this doctor understand what she’s going through? Will this doctor judge her? How will she be empowered enough to talk about her sexual risks? The kind of research I want to do will help improve both the patient and provider relationships.”
From public to private health
Watson, who has been working in Public Health for more than 20 years, decided to leave the corporate world to pursue more social and behavioral health research.
“I’ve gone through TCSPP’s Organizational Leadership and Psychology degree program now for two years,” Watson says. “And there’s communication that’s missing. We’ve gotten technology that makes this disease a more chronic illness. But if you separate the stigma, you separate the concept of policy and access. If you’re HIV positive, you can get access to amazing technologies and medications that could work for a full-life expectancy. And if you’re negative, you now have biomedical options in concert of understanding one’s own risk that could really mitigate acquisition.”
But with all of these health improvements, if patients don’t know about them, it’s a moot point. In Watson’s Leader Fellowship provided by TCSPP from January to June 2018, he has the opportunity to implement and evaluate a community-based project for a nonprofit organization.
These are the three health phases Watson plans to help expand to a wider audience.
“My first goal is to make sure that more people of color understand how they can gain access to this technology. My second goal is to build a blueprint to move forward with social and behavioral research around this topic, especially surrounding gay, black men. And my third goal is to help providers better understand microaggressions, cultural sensitivity around sexual practices, and to identify key groups that need more training. Ultimately this fellowship would be a pilot program to improve the overall healthcare system.”
Shamontiel L. Vaughn
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