Affirming Healthcare Experiences Among Older Black- and White-Identifying Gay Men Living With Serious Illness: A Qualitative Study in the Deep South.

Background: Older gay men living with serious illness often face challenges related to identity, disclosure, and relational recognition in healthcare settings. These challenges are particularly acute in the Deep South, where affirming care remains inconsistent, and disparities persist.Objective: To examine serious illness care experiences among older Black- and White-identifying gay men and their caregivers, with attention to how communication, inclusion, and identity disclosure shaped patient-clinician interactions.Design: Using a community-based participatory research framework, we partnered equitably with a Community Advisory Board of older gay men to guide study design, interview development, recruitment, and analysis. Semi-structured interviews were conducted with 16 participants (11 patients and 5 caregivers), intentionally sampling both Black- and White-identifying gay men. Reflexive thematic analysis was used to identify patterns in care experiences.Results: Three main themes were identified: (1) Experiences of Inclusion and Visibility, (2) Positive Communication, and (3) Sharing Sexuality and Effect on Care. Participants described moments of interpersonal connection and respect that fostered trust and comfort. Clear communication, honesty, and opportunities to ask questions were critical in navigating medical decisions. Discussions of sexual orientation were context-dependent and often shaped by perceptions of safety. Recognition of chosen family members, particularly partners, was central to participants' sense of dignity and affirmation in care.Conclusions: Findings highlight the importance of visibility, clinician-patient communication, and relationship recognition in serious illness care for older gay men. Culturally responsive, identity-affirming practices are essential to delivering equitable palliative and hospice care, particularly in underserved regions of the U.S. South.