Perceived discrimination in clinical care in a nationally representative sample of HIV-infected adults receiving health care

Abstract

Background: Perceived discrimination in clinical settings could discourage HIV‐infected people from seeking health care, adhering to treatment regimens, or returning for follow‐up. Objectives: This study aims to determine whether HIV‐infected people perceive that physicians and other health care providers have discriminated against them. Design, Participants: Cross‐sectional data (1996 to 1997) from the HIV Cost and Services Utilization Study (HCSUS), which conducted in‐person interviews with a nationally representative probability sample of 2,466 HIV‐infected adults receiving health care within the contiguous U.S. Measurements: Reports of whether health care providers have been uncomfortable with the respondent, treated the respondent as an inferior, preferred to avoid the respondent, or refused the respondent service. Questions also covered the types of providers who engaged in these behaviors. Results: Twenty‐six percent of HIV‐infected adults receiving health care reported experiencing at least 1 of 4 types of perceived discrimination by a health care provider since becoming infected with HIV, including 8% who had been refused service. White respondents (32%) were more likely than others (27%) and Latinos (21%) and nearly twice as likely as African Americans (17%) to report perceived discrimination (P<.001). Respondents whose first positive HIV test was longer ago were also more likely to report discrimination (P<.001). Respondents who reported discrimination attributed it to physicians (54%), nurses and other clinical staff (39%), dentists (32%), hospital staff (31%), and case managers or social workers (8%). Conclusions: Many HIV‐infected adults believe that their clinicians have discriminated against them. Clinicians should make efforts to address circumstances that lead patients to perceive discrimination, whether real or imagined.

Development and Psychometric Assessment of a Multidimensional Measure of Internalized HIV Stigma in a Sample of HIV-positive Adults

“…While a few scales exist to measure perceived stigma specifically from health care providers (Bodenlos et al, 2004;Kinsler et al, 2007;Schuster et al, 2005), other existing measures of stigma in PLHA do not include items that also address stigma in the context of HIV treatment. We found stigma in the health care setting and related to ART to be highly relevant in our formative work and the peer-reviewed literature, and we have included items in our measure that tap these concepts (items 1, 10, 13, 14, 1, 18, 19).…”

Stigma and Sexual Health Risk in HIV-Positive African American Young Men Who Have Sex with Men

“…[1][2][3] From 1994 to 1998, Centers for Disease Control and Prevention (CDC) surveys found that 14% of adolescent and young adult African American MSM participants (n ¼ 4000) were infected with HIV. 4 More recent CDC findings raise further concern, suggesting a 93% increase in the number of HIV/AIDS cases among African American MSM aged [13][14][15][16][17][18][19][20][21][22][23][24] years between 2001 and 2006. 5 These alarming statistics highlight the urgent need for HIV/AIDS prevention efforts targeting young African American MSM.…”

Experiences of HIV-Related Stigma Among Young Men Who Have Sex with Men

“…5,6 HIV-related stigma and discrimination have also been identified as barriers to seeking appropriate healthcare for people living with HIV. 7,8 In a study of HIV-positive adolescents, half of participants reported skipping medication doses to avoid disclosure of HIV status to friends and family. 9 Other authors have clearly linked experience of HIV stigma with increased rates of depression.…”