Sociodemographic Correlates of Self-Reported Discrimination in HIV Health Care Settings Among Persons With Diagnosed HIV in the United States, Medical Monitoring Project, 2018–2019

Donna Hubbard McCree, PhD, MPH, RPh; Linda Beer, PhD; William L. Jeffries IV, PhD, MPH, MA; Yunfeng Tie, PhD; Jennifer Fagan, MA; Stacy M. Crim, MPH

Disclosures

J Acquir Immune Defic Syndr. 2021;88(5):457-464. 

In This Article

Abstract and Introduction

Abstract

Background: HIV-related discrimination in health care settings is associated with negative health outcomes among persons with HIV (PWH). This article describes and compares differences in the prevalence of self-reported experiences with discrimination in health care settings by sociodemographic and clinical care factors among persons with diagnosed HIV in the United States.

Methods: We analyzed interview and medical record data collected during June 2018–May 2019 from 3850 PWH who had received HIV care in the past 12 months. We calculated weighted percentages and associated 95% confidence intervals and assessed the association between any experience of discrimination and selected sociodemographic and clinical characteristics using prevalence ratios with predicted marginal means.

Results: Approximately 25% of PWH who had an HIV care visit in the past 12 months reported experiencing any discrimination. Experiences with discrimination were significantly more prevalent among persons aged 18–29 years (34%); transgender persons (41%); persons of gay (25%), bisexual (31%), or other (40%) sexual orientations; and persons who did not have a regular provider (39%), lived at/below poverty level (28%), were homeless (39%) or incarcerated (37%) in the past 12 months. PWH who experienced discrimination were more likely to have missed at least one HIV care visit, not be taking antiretroviral therapy, and have missed antiretroviral therapy doses. Recent and sustained viral suppression were not significantly associated with experiencing any discrimination.

Conclusions: Interventions that address the sociocultural and structural factors associated with discrimination in all health care settings are needed to improve health outcomes among PWH and end the HIV epidemic in the United States.

Introduction

The Ending the HIV Epidemic in the United States (EHE; Ending the HIV Epidemic: A Plan for America|Centers for Disease Control and Prevention, https://www.cdc.gov/endhiv/index.html) initiative will use 3 key strategies—diagnose, treat, and prevent—to reduce new HIV infections in the United States by at least 90% by 2030. A key to the success of EHE in reducing HIV incidence is ensuring that all persons with HIV (PWH) receive appropriate treatment and are virally suppressed to reduce transmission to others through sex. Achieving success will also require providers and prevention partners to identify and address factors that negatively affect access to treatment and care among PWH, including experiences with stigma and discrimination by health care providers based on race/ethnicity, socioeconomic status, gender, gender identity, and HIV status.[1–6]

HIV-related stigma is a social process that occurs in the context of power and entails negative beliefs and attitudes toward persons with or at risk of HIV infection.[7–9] HIV-related discrimination, an outcome of HIV-related stigma,[7–9] is unfair and unjust treatment of individuals because of their HIV status and/or their membership in a group perceived to be at greater risk of HIV.[7–9] HIV-related discrimination can occur in the presence of other forms of discrimination, for example, discrimination based on race, sex, gender or gender identity, and sexual orientation.[7] In health care settings, discrimination can result in poorer quality or denial of care for PWH.[2] It is also associated with poorer health outcomes, including depression,[10–13] reduced linkage to care,[10–13] negative patient–provider relationships,[14–17] lower antiretroviral therapy (ART) adherence,[14–17] and lower viral suppression in PWH.[12] Therefore, efforts are needed to identify experiences with, and inform strategies to address, HIV-related discrimination in HIV health care settings among PWH.

The purpose of this article is to describe and compare differences in the prevalence of self-reported experiences of discrimination in health care settings by sociodemographic and clinical care factors using Medical Monitoring Project (MMP) data on PWH in the United States. Specifically, we aim to (1) describe the prevalence of, and perception of reasons for, self-reported experiences of health care discrimination and (2) compare differences in self-reported experiences of discrimination in HIV health care settings by sociodemographic and clinical care factors.

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