"She's Always Made Sure That We Had Black Doctors, Particularly Women Doctors If We Could… and How It Can Sometimes Be the Difference Between Life and Death." Black College Women's Reflections On Medical Racism As a Social Determinant of Health.

Historical instances of medical racism and the impact of ongoing disparities are an understudied determinant of Black women's sexual health. Here, we use a Black feminist approach to engage Black women in a qualitative exploration of the impact of medical racism on their health-related decision-making. Specifically, we explore the question, how does exposure to information on medical racism impact Black women today and inform their perceptions of healthcare? This qualitative study uses Black feminist approaches to study design including advisory boards, interviewer concordance, and focus group data collection with Black female college students who were in the developmental phase of emerging adulthood, ages 18-25. We also led seven virtual focus groups that focused on dialogue around agents of sexual socialization including knowledge of historical and ongoing medical racism. Four themes emerged from our thematic analysis. The first theme was compromised mental health. The second theme was a wealth and health paradox whereby income and education did not mitigate the impact of racism on health. The third theme was medical racism and distrust. And the fourth theme was around the role of Black Americans as guinea pigs, autonomous actors, and advocates in healthcare. Medical racism, whether it is experienced firsthand, vicariously, or as a part of one's history, is a source of anxiety for Black women. This barrier to care must be addressed to promote health equity in the USA.