HIV-Related Stigma Among Healthcare Providers in the Deep South

Abstract

Stigma towards people living with HIV (PLWH) in healthcare settings is a barrier to optimal treatment. However, our understanding of attitudes towards PLWH from healthcare providers’ perspective in the United States is limited and out-of-date. We assessed HIV-related stigma among healthcare staff in Alabama and Mississippi, using online questionnaires. Participants included 651 health workers (60 % White race; 83 % female). Multivariate regression suggests that several factors independently predict stigmatizing attitudes: Protestant compared to other religions (β = 0.129, p ≤ 0.05), White race compared to other races (β = 0.162, p ≤ 0.001), type of clinic (HIV/STI clinic: β = 0.112, p ≤ 0.01), availability of post-exposure prophylaxis (yes: β = −0.107, p ≤ 0.05), and perceptions of policy enforcement (policies not enforced: β = 0.058, p = p ≤ 0.05). These findings may assist providers wishing to improve the quality care for PLWH. Enforcement of policies prohibiting discrimination may be a useful strategy for reducing HIV-related stigma among healthcare workers.

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References

  1. 1.

    Giordano TP, Gifford AL, White AC Jr, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.

    PubMed  Article  Google Scholar 

  2. 2.

    Katz IT, Ryu AE, Onuegbu AG, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013;16:18640.

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care STDs. 2007;21:584–92.

    PubMed  Article  Google Scholar 

  4. 4.

    Mahajan AP, Sayles JN, Patel VA, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS. 2008;22:S67.

    PubMed  PubMed Central  Article  Google Scholar 

  5. 5.

    Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24:1101–8.

    PubMed  PubMed Central  Article  Google Scholar 

  6. 6.

    Turan JM, Bukusi EA, Onono M, Holzemer WL, Miller S, Cohen CR. HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS Study. AIDS Behav. 2011;15:1111–20.

    PubMed  PubMed Central  Article  Google Scholar 

  7. 7.

    Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006;10:473–82.

    PubMed  PubMed Central  Article  Google Scholar 

  8. 8.

    Holzemer WL, Human S, Arudo J, et al. Exploring HIV stigma and quality of life for persons living with HIV infection. J Assoc Nurses AIDS Care. 2009;20:161–8.

    PubMed  Article  Google Scholar 

  9. 9.

    Vyavaharkar M, Moneyham L, Corwin S, Saunders R, Annang L, Tavakoli A. Relationships between stigma, social support, and depression in HIV-infected African American women living in the rural Southeastern United States. J Assoc Nurses AIDS Care. 2010;21:144–52.

    PubMed  PubMed Central  Article  Google Scholar 

  10. 10.

    Herek GM, Saha S, Burack J. Stigma and psychological distress in people with HIV/AIDS. Basic Appl Soc Psychol. 2013;35:41–54.

    Article  Google Scholar 

  11. 11.

    National HIV/AIDS strategy for the United States. The White House Office of National Aids Policy; 2010.

  12. 12.

    National HIV/AIDS strategy for the United States: Updated to 2020. The White House Office of National Aids Policy; 2015.

  13. 13.

    Sears B. HIV discrimination in health care services in Los Angeles County: the results of three testing studies. Wash Lee J Civ Rts Soc Justice. 2008;15:85.

    Google Scholar 

  14. 14.

    Zukoski AP, Thorburn S. Experiences of stigma and discrimination among adults living with HIV in a low HIV-prevalence context: a qualitative analysis. AIDS Patient Care STDS. 2009;23(4):267–76.

    PubMed  Article  Google Scholar 

  15. 15.

    Sayles JN, Ryan GW, Silver JS, Sarkisian CA, Cunningham WE. Experiences of social stigma and implications for healthcare among a diverse population of HIV positive adults. J Urban Health. 2007;84:814–28.

    PubMed  PubMed Central  Article  Google Scholar 

  16. 16.

    Schuster MA, Collins R, Cunningham WE, et al. Perceived discrimination in clinical care in a nationally representative sample of HIV-infected adults receiving health care. J Gen Intern Med. 2005;20:807–13.

    PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Marcenko MO, Samost L. Living with HIV/AIDS: the voices of HIV-positive mothers. Soc Work. 1999;44(1):36–45.

    PubMed  Article  Google Scholar 

  18. 18.

    Blake BJ, Jones Taylor GA, Reid P, Kosowski M. Experiences of women in obtaining human immunodeficiency virus testing and healthcare services. J Am Acad Nurse Pract. 2008;20(1):40–6.

    PubMed  Article  Google Scholar 

  19. 19.

    Buscher A, Hartman C, Kallen MA, Giordano TP. Validity of self-report measures in assessing antiretroviral adherence of newly diagnosed, HAART-naive, HIV patients. HIV Clin Trials. 2011;12(5):244–54.

    PubMed  PubMed Central  Article  Google Scholar 

  20. 20.

    Rintamaki LS, Scott AM, Kosenko KA, Jensen RE. Male patient perceptions of HIV stigma in health care contexts. AIDS Patient Care STDS. 2007;21(12):956–69.

    PubMed  Article  Google Scholar 

  21. 21.

    Elford J, Ibrahim F, Bukutu C, Anderson J. HIV-related discrimination reported by people living with HIV in London, UK. AIDS Behav. 2008;12(2):255–64.

    PubMed  Article  Google Scholar 

  22. 22.

    Lindau ST, Jerome J, Miller K, Monk E, Garcia P, Cohen M. Mothers on the margins: implications for eradicating perinatal HIV. Soc Sci Med. 2006;62(1):59–69.

    PubMed  Article  Google Scholar 

  23. 23.

    Surlis S, Hyde A. HIV-positive patients’ experiences of stigma during hospitalization. J Assoc Nurses AIDS Care. 2001;12(6):68–77.

    PubMed  CAS  Article  Google Scholar 

  24. 24.

    Wingood GM, DiClemente RJ, Mikhail I, et al. HIV discrimination and the health of women living with HIV. Women Health. 2007;46(2–3):99–112.

    PubMed  Article  Google Scholar 

  25. 25.

    Control CfD, Prevention. HIV surveillance report, vol. 23; February 2013. HIV diagnosis data are estimates from all. 2014;50.

  26. 26.

    Reif SS, Whetten K, Wilson ER, et al. HIV/AIDS in the Southern USA: a disproportionate epidemic. AIDS Care. 2014;26(3):351–9.

    PubMed  Article  Google Scholar 

  27. 27.

    Heckman TG, Somlai AM, Peters J, et al. Barriers to care among persons living with HIV/AIDS in urban and rural areas. AIDS Care. 1998;10(3):365–75.

    PubMed  CAS  Article  Google Scholar 

  28. 28.

    Reif S, Golin CE, Smith SR. Barriers to accessing HIV/AIDS care in North Carolina: rural and urban differences. AIDS Care. 2005;17(5):558–65.

    PubMed  CAS  Article  Google Scholar 

  29. 29.

    Baunach DM, Burgess EO. HIV/AIDS prejudice in the American Deep South. Soc Spectr. 2013;33(2):175–95.

    Article  Google Scholar 

  30. 30.

    Currey CJ, Johnson M, Ogden B. Willingness of health-professions students to treat patients with AIDS. Acad Med. 1990;65(7):472–4.

    PubMed  CAS  Article  Google Scholar 

  31. 31.

    Boehme AK, Moneyham L, McLeod J, et al. HIV-infected women’s relationships with their health care providers in the rural deep south: an exploratory study. Health Care Women Int. 2012;33(4):403–19.

    PubMed  Article  Google Scholar 

  32. 32.

    Lichtenstein B. Stigma as a barrier to treatment of sexually transmitted infection in the American deep south: issues of race, gender and poverty. Soc Sci Med. 2003;57:2435–45.

    PubMed  Article  Google Scholar 

  33. 33.

    Li L, Wu Z, Wu S, Zhaoc Y, Jia M, Yan Z. HIV-related stigma in health care settings: a survey of service providers in China. AIDS Patient Care STDS. 2007;21(10):753–62.

    PubMed  PubMed Central  Article  Google Scholar 

  34. 34.

    Andrewin A, Chien L-Y. Stigmatization of patients with HIV/AIDS among doctors and nurses in Belize. AIDS Patient Care STDS. 2008;22(11):897–906.

    PubMed  Article  Google Scholar 

  35. 35.

    Ekstrand ML, Ramakrishna J, Bharat S, Heylen E. Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions. J Int AIDS Soc. 2013;16(3Suppl 2):18717.

    PubMed  PubMed Central  Google Scholar 

  36. 36.

    Feyissa GT, Abebe L, Girma E, Woldie M. Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health. 2012;12(1):522.

    PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Foreman M, Lyra P, Breinbauer C. Understanding and responding to HIV/AIDS-related stigma and stigma-discrimination in the health sector. Washington: Pan American Health Organization; 2003.

    Google Scholar 

  38. 38.

    Vyas KJ, Patel GR, Shukla D, Mathews WC. A comparison in HIV-associated stigma among healthcare workers in urban and rural Gujarat. SAHARA J. 2010;7(2):71–5.

    PubMed  Article  Google Scholar 

  39. 39.

    Kopacz DR, Grossman LS, Klamen DL. Medical students and AIDS: knowledge, attitudes and implications for education. Health Educ Res. 1999;14(1):1–6.

    PubMed  CAS  Article  Google Scholar 

  40. 40.

    Rogers SJ, Tureski K, Cushnie A, Brown A, Bailey A, Palmer Q. Layered stigma among health-care and social service providers toward key affected populations in Jamaica and The Bahamas. AIDS Care. 2014;26(5):538–46.

    PubMed  CAS  Article  Google Scholar 

  41. 41.

    Bennett ME, Weyant RJ, Wallisch JM, Green G. Dentists’attitudes toward the treatment of HIV-positive patients. J Am Dent Assoc. 1995;126(4):509–14.

    PubMed  CAS  Article  Google Scholar 

  42. 42.

    Brown L, Macintyre K, Trujillo L. Interventions to reduce HIV/AIDS stigma: what have we learned? AIDS Educ Prev. 2003;15(1):49–69.

    PubMed  Article  Google Scholar 

  43. 43.

    Nyblade L, Jain A, Benkirane M, et al. A brief, standardized tool for measuring HIV-related stigma among health facility staff: results of field testing in China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis. J Int AIDS Soc. 2013;16(2):18718.

    PubMed  PubMed Central  Google Scholar 

  44. 44.

    Tabachnick BG, Fidell LS. Cleaning up your act: screening data prior to analysis. In: Tabachnick BG, Fidell LS, editors. Using multivariate statistics. Boston: Allen and Bacon; 2001. p. 56–110.

    Google Scholar 

  45. 45.

    Nyblade LC. Measuring HIV stigma: existing knowledge and gaps. Psychol Health Med. 2006;11:335–45.

    PubMed  Article  Google Scholar 

  46. 46.

    Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works? J Int AIDS Soc. 2009;12(1):15.

    PubMed  PubMed Central  Article  Google Scholar 

  47. 47.

    UNAIDS. UNAIDS: indicator registry. http://www.indicatorregistry.org. Accessed 1 June 2015.

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Acknowledgements

This research was supported by the University of Alabama at Birmingham (UAB) Center For AIDS Research CFAR, an NIH funded program (P30 AI027767) that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA,NIA, NIDDK, NIGMS, and OAR, as well as by the UAB School of Public Health, and the Alabama Public Health Training Center (AL PHTC; UB6HP22824). Kristi Stringer is supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number F31DA037106. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Kristi L. Stringer.

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Stringer, K.L., Turan, B., McCormick, L. et al. HIV-Related Stigma Among Healthcare Providers in the Deep South. AIDS Behav 20, 115–125 (2016). https://doi.org/10.1007/s10461-015-1256-y

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Keywords

  • HIV/AIDS
  • Healthcare workers
  • Stigma
  • United States