Patient-Provider Relationship| Volume 29, ISSUE 4, P308-314, July 2019

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Patient–Provider Sexually Transmitted Infection Prevention Communication among Young Adult Sexual Minority Cisgender Women and Nonbinary Assigned Female at Birth Individuals

  • Jaquelyn L. Jahn
    Correspondence to: Jaquelyn L. Jahn, MPH, PhD Candidate, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, 7th Floor, Boston, MA 02115. Phone: 847-212-7262; fax: 617-432-3123.
    Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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  • Rachel A. Bishop
    Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

    MassHealth, Office of Medicaid, Executive Office of Health & Human Services, Commonwealth of Massachusetts, Boston, Massachusetts
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  • Andy S.L. Tan
    Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

    Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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  • Madina Agénor
    Department of Community Health, Tufts University, Medford, Massachusetts
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Published:February 25, 2019DOI:



      Health care providers are an important source of sexually transmitted infection (STI) prevention information for young adult sexual minority women (SMW). However, very few studies have described patient–provider STI communication in this understudied and underserved population. We explore sexual minority women's experiences communicating with health care providers about sexual health, with particular attention to STI prevention, to inform programs and practices that address their unique needs and concerns.


      We conducted 29 in-depth interviews with sexual minority cisgender women and nonbinary assigned female at birth (AFAB) individuals aged 18–36 years. The sample included White (55%), Asian (31%), Black (17.2%), and Latina (3.4%) participants. We used thematic analysis with deductive and inductive coding to identify themes related to patient–provider STI prevention communication.


      Heteronormative health care provider assumptions inhibited participants' willingness to disclose their sexual orientation and discuss sexual health issues with providers. Most sexual health conversations focused on pregnancy and contraception, which many felt was irrelevant to them, and limited STI prevention recommendations to condom use. Participants reported that some providers lacked medical knowledge on AFAB-to-AFAB STI transmission and were not able to provide relevant STI prevention information. Providers' bias related to gender identity and race/ethnicity furthered some participants' mistrust generated from providers’ heteronormative assumptions.


      Our study describes several barriers that AFAB sexual minorities felt inhibited their patient–provider sexual health communication. Interventions are needed to improve patient–provider STI prevention conversations with AFAB sexual minorities so they can access the sexual health information they need to effectively protect themselves from STIs.
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      Jaquelyn L. Jahn, MPH, is a doctoral candidate at the Harvard T.H. Chan School of Public Health in the Department of Social and Behavioral Sciences. Her social epidemiologic research focuses on health inequities across gender, sexual orientation, and race/ethnicity.


      Rachel A. Bishop, MPH, works to address systemic health inequities as Manager of External Affairs at MassHealth in the Office of Medicaid for the Commonwealth of Massachusetts.


      Andy S.L. Tan, PhD, MPH, MBA, is Assistant Professor, Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health. His research is aimed at understanding health communication processes that contribute the burden of cancer and disparities across the cancer control continuum.


      Madina Agénor, ScD, MPH, is Gerald R. Gill Assistant Professor of Race, Culture, and Society, Tufts University. She investigates health/health care inequities in relations to various dimensions of social inequality, especially sexual orientation, gender identity, and race/ethnicity, using an intersectional lens.