When Provider Contact Does Not Become PrEP Care.

Abstract

Pre-exposure prophylaxis (PrEP) uptake among sexual and gender minority (SGM) populations remains unequal across intersecting lines of race, gender identity, and socioeconomic position, even when awareness and prior provider discussion are present. This conceptual article treats these disparities as communication inequality visible at the clinical encounter, where provider contact can occur without converting into actionable care. Drawing on Lin's network theory of social capital, it recasts provider contact as a mobilization event whose value depends on its return, and locates the disparity in a return deficit, in which formally similar resources yield unequal outcomes across groups. Intersectional discrimination shapes this conversion through patient-side disclosure costs and provider-side recognition failures, in which PrEP candidacy is not registered despite contact. The framework shifts the central question from whether provider discussion occurs to what the encounter produces, redirecting analysis and intervention toward these conversion endpoints.