Reading this transcript was a little difficult at first as there were a lot of abbreviations, terms and context that I was not familiar with. Reading through the transcript made me appreciate how it can be important to have some familiarity with the subject matter of the transcript as some layers of meaning can be lost if one doesn’t know the greater setting the interview takes place in. Talking to Sarah and Nika, both family planning fellows, gave better context to the interview, but also likely colored my interpretation based on their feelings and beliefs.
One of the themes/codes we discussed in section that was provider fear of counseling patients of who had just seroconverted to HIV. Quotes that I marked with this code included:
“[when] someone is HIV positive or zero converts, family planning providers freak out” line 221-222
“The provider freaked out and said you might have HIV” line 228
“Someone seroconverts and so we’re like “uhhh, I’m sooooo sorry” line 258
The repetition of the words “freak out” was very striking to me as it was very clear in conveying the discomfort some of these providers had with canceling HIV positive patients.
This was in juxtaposition to the relative provider comfort with providing treatment for other STI such as chlamydia. Quotes that I marked with this code included:
“there’s a lot of comfort around EC and chlamydia”
These things seem to be more in the established realm of family planning, where as HIV seems foreign.
This fear of HIV may related to how many see HIV and sexual/reproductive health as separate and foreign:
“I started in doing sexual health and reproductive health before I moved on to doing like HIV work” 267-268
Some providers felt that their patients didn’t need Prep as they were low risk for HIV. This seems to play in to this feeling that HIV patients are not family provider patients. Quotes that I marked with this code included:
“…who’s the righ candidate? …because, just because getting like chlamydia repeatedly doesn’t necessarily mean that they’re going to acquire HIV” 211-212
“low income urban setting women who want birth control and chlamydia treatment” 202-203
“HIV is not just something that women don’t have to worry about” 276-277
“A lot of our clinics do do rapid testing which is fantastic …they don’t have a lot of positivity in their area…it just not something that going to come up a lot” 324-326
Which leads into another important theme that came up around who is a family provider patient? There seemed to be a lot of resistance to seeing men as patients and HIV positive patients. Quotes that I marked with this code included:
“so now you to take that whole (picture? Future?) -- Shift from we do birth control and pap smears to now, you know working with MSM populations” 300-301
“providers who are not used to working with young gay men” 303
Some of the resistance to become HIV providers seemed to be around increased resource utilization and lack of familiarity with HIV. Quotes that I marked with this code included:
“doing that in the context of the work that we’re already doing that ask for PreP I think just feels so hard” 205-206
“providers are already taxed, like there are too few family planning providers” 201-202
“call counseling you’re supposed to go through, how to order it – it will take more and more time to just do that one service” 320-321
Lastly something interesting that came up was CDC metrics and their shaping of care provided. Quotes that I marked with this code included:
“if you want to get money for HIV form CDC, it’s MSM. Young MSM of color specifically” 291-292
“funding is tied to how well you get people on LARCs”340-341
“Hiding behind…very thin rouse of trying to like meet whatever the funding requirements were and like not dance too much on the fact like I going to tell you how to live your life even though like living your life is not a CDC deliverable” 393-397
I thought how metric drives care was really interesting and it seemed to generate some of the feelings of resentment against Prep.