Provider Stigma Toward HIV Slows Prevention Goals

Reducing stigma surrounding HIV is critical for combating new HIV infections and increasing linkage to and retention in HIV care. However, according to CDC researchers, healthcare providers’ stigma toward patients with HIV is impeding on HIV prevention goals.

There are currently 1.2 million people living with HIV in the United States, and while data has demonstrated an annual decline in HIV diagnoses from 2010 to 2014, there are still 39,000 new cases of HIV diagnosed each year. And while treatment advancements, such as pre-exposure prophylaxis (PrEP) and antiretroviral therapy, have come to market, there are prevalent factors limiting access to these treatments.

“National strategies to prevent new HIV infections and ensure that people living with HIV are linked to and retained in care have identified HIV-related stigma as a primary barrier to seeking HIV services,” according to the study researchers. “Patients seeking preventive services and people living with HIV seeking treatment services have encountered HIV-related stigma from healthcare providers in both traditional (clinical) and nontraditional (community-based) setting.”

Impacts of this stigma include decreased HIV testing, condom use, PrEP and medication adherence, linkage to care, and retention in care.

As physicians have an essential role in the fight against HIV—leading patients through the care continuum—understanding HIV-related stigma among physicians can inform development of interventions to reduce this stigma and promote positive clinical outcomes.

The researchers conducted a systematic review of 6 studies published between January 2010 and 2017 and identified 3 themes: attitudes, beliefs, and behaviors; quality of patient care; and education and training.

They found that the frequency of stigma varied by care setting and provider category, and factors associated with stigmatizing behaviors, attitudes, and beliefs varied by gender, race, religion, provider category, and setting of care. Those who were white, male, primary care physicians and those with limited or no HIV-stigma training in the past 12 months were more likely to have stigma toward patients with HIV.

“Some findings suggest that patients are often stigmatized as being poor, having a high number of sexual partners in their lifetime, and frequently engaging in other risky sexual behavior,” wrote the researchers. “Providers also believed that these stigmatizing beliefs and behaviors were based on historically negative portrayals of persons at risk for HIV, people living with HIV, and persons who seek HIV prevention and care services.”

Provider fear of acquiring HIV through occupational exposure led to reduced quality of care, refusal of care, and anxiety when providing services to people living with HIV. The researchers also observed that limited opportunities for clinical education and practice for non-HIV specialty doctors facilitated provider HIV-stigma.

Reference

Geter A, Herron A, Sutton M. HIV-related stigma by healthcare providers in the United States: A systematic review [published online October 2, 2018]. AIDS Patient Care STDs. doi: https://doi.org/10.1089/apc.2018.0114.