The Effect of Perceived Stigma from a Health Care Provider on Access to Care Among a Low-Income HIV-Positive Population

Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA.
AIDS PATIENT CARE and STDs (Impact Factor: 3.5). 09/2007; 21(8):584-92. DOI: 10.1089/apc.2006.0202
Source: PubMed


Perceived stigma in clinical settings may discourage HIV-infected individuals from accessing needed health care services. Having good access to care is imperative for maintaining the health, well being, and quality of life of persons living with HIV/AIDS (PLWHAs). The purpose of this prospective study, which took place from January 2004 through June 2006, was to evaluate the relationship between perceived stigma from a health care provider and access to care among 223 low income, HIV-infected individuals in Los Angeles County. Approximately one fourth of the sample reported perceived stigma from a health care provider at baseline, and about one fifth reported provider stigma at follow up. We also found that access to care among this population was low, as more than half of the respondents reported difficulty accessing care at baseline and follow up. Perceived stigma was found to be associated with low access to care both at baseline (odds ratio [OR] = 3.29; 95% confidence interval [CI] = 1.55, 7.01) and 6-month follow up (2.85; 95% CI = 1.06, 7.65), even after controlling for sociodemographic characteristics and most recent CD4 count. These findings are of particular importance because lack of access or delayed access to care may result in clinical presentation at more advanced stages of HIV disease. Interventions are needed to reduce perceived stigma in the health care setting. Educational programs and modeling of nonstigmatizing behavior can teach health care providers to provide unbiased care.

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    • "Successful communication is highly dependent on the interpersonal skills of doctors and other staff members and their ability to treat clients with respect and understanding.10 In a study conducted in Los Angeles County, patients with HIV perceived stigma from health care providers in both baseline and follow up stages.11 This could have the effect of decreasing the number of patients seeking help and services and ultimately lead to delayed access with serious clinical symptoms and signs. "
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    ABSTRACT: Background Since 2000, Iran has been delivering training and treatment services, including methadone therapy, to human immunodeficiency virus (HIV) positive patients through triangular clinics. This study aims to evaluate the effectiveness of these activities at the HIV Triangulation Centre in the city of Kerman, Iran, through clients’ views. Methods Participants were recruited using a convenience sample and assessed through in-depth interviews, and observations. Data were analyzed using a thematic analysis, matrix based method. Findings The results found problems in training and counseling which was described by the staff to be due to the effects of the economic difficulties of the clients, not being of the same sex as the consultant, and lack of utilization of a variety of training methods by the clients. Furthermore, the absorption of clients was perceived as being affected by the appearance of the center, gossip around the center, limited working hours, and interpersonal relations between clients and staff. The clients also criticized the building of the center as it failed to maintain anonymity of the patients. The need for supplementary services, such as dentistry, was perceived by many clients. Conclusion The application of appropriate strategies such as providing adequate training and removing the obstacles of absorption should be taken into account to increase the utility and coverage of the triangular clinic. These interventions could be a range of activities, such as relocating the center to a more decent place and encouraging the staff to appear in a professional white coat to help gain the trust of clients.
    03/2014; 6(1-2):14-21.
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    • "Symptoms of depression have been associated with poor virologic response [58], [59], [60], reduced immunologic capacity [61], and AIDS and non-AIDS related death among individuals on ART [49], [62], [63], [64], [65]. Feelings of guilt, fear and discrimination have been associated with delayed access to HIV treatment and care [66], and non-adherence to ART [67], [68], [69]. A recent study of 9,003 HIV-positive individuals in the US found that presence of mental health disorders, including schizophrenia and bi-polar disorder, were significantly associated with all-cause mortality [70]. "
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    ABSTRACT: Little is known about the potential impact of food insecurity on mortality among people living with HIV/AIDS. We examined the potential relationship between food insecurity and all-cause mortality among HIV-positive injection drug users (IDU) initiating antiretroviral therapy (ART) across British Columbia (BC). Cross-sectional measurement of food security status was taken at participant ART initiation. Participants were prospectively followed from June 1998 to September 2011 within the fully subsidized ART program. Cox proportional hazard models were used to ascertain the association between food insecurity and mortality, controlling for potential confounders. Among 254 IDU, 181 (71.3%) were food insecure and 108 (42.5%) were hungry. After 13.3 years of median follow-up, 105 (41.3%) participants died. In multivariate analyses, food insecurity remained significantly associated with mortality (adjusted hazard ratio [AHR] = 1.95, 95% CI: 1.07-3.53), after adjusting for potential confounders. HIV-positive IDU reporting food insecurity were almost twice as likely to die, compared to food secure IDU. Further research is required to understand how and why food insecurity is associated with excess mortality in this population. Public health organizations should evaluate the possible role of food supplementation and socio-structural supports for IDU within harm reduction and HIV treatment programs.
    PLoS ONE 05/2013; 8(5):e61277. DOI:10.1371/journal.pone.0061277 · 3.23 Impact Factor
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    • "However, unlike the settings of other analyses, our study was conducted within a context of universal coverage for all medically necessary physician, laboratory and inpatient services. Consequently, differences in rates of hospital admission according to sex, socio-economic status or immigration status should not be confounded by health insurance status, which thus implies a role for other biological, social or structural factors in these disparities, including stigma, non-disclosure of HIV status, drug addiction and coexisting mental health disease.24-30 "
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    ABSTRACT: Among people living with HIV infection in the era of combination antiretroviral therapy (cART), admission to hospital may indicate inadequate community-based care. As such, population-based assessments of the utilization of inpatient services represent a necessary component of evaluating the quality of HIV-related care. We used a validated algorithm to search Ontario's administrative health care databases for all persons living with HIV infection aged 18 years or older between 1992/93 and 2008/09. We then conducted a population-based study using time-series and longitudinal analyses to first quantify the immediate effect of cART on hospital admission rates and then analyze recent trends (for 2002/03 to 2008/09) in rates of total and HIV-related admissions. The introduction of cART in 1996/97 was associated with more pronounced reductions in the rate of hospital admissions among men than among women (for total admissions, -89.9 v. -60.5 per 1000 persons living with HIV infection, p = 0.003; for HIV-related admissions, -56.9 v. -36.3 per 1000 persons living with HIV infection, p < 0.001). Between 2002/03 and 2008/09, higher rates of total hospital admissions were associated with female sex (adjusted relative rate [RR] 1.15, 95% confidence interval [CI] 1.05-1.27) and low socio-economic status (adjusted RR 1.21, 95% CI 1.14-1.29). Higher rates of HIV-related hospital admission were associated with low socio-economic status (adjusted RR 1.30, 95% CI 1.17-1.45). Recent immigrants had lower rates of both total admissions (adjusted RR 0.70, 95% CI 0.61-0.80) and HIV-related admissions (adjusted RR 0.77, 95% CI 0.61-0.96). We observed important socio-economic- and sex-related disparities in rates of hospital admission among people with HIV living in Ontario, Canada.
    Open Medicine 11/2012; 6(4):e146-e154.
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