Physicians might want to be extra careful about how they treat HIV-infected patients --not just in the clinical sense but in the way they behave toward them.
Even the perception that physicians are stigmatizing patients for carrying the virus that causes AIDS can discourage these individuals from seeking proper medical care, according to a new UCLA study.
The study, published in the August issue of the peer-reviewed journal AIDS Patient Care and STDs, found that up to one-fourth of patients surveyed in the Los Angeles area reported feeling stigmatized by their health care providers. This perception was also linked to low access to care among these patients, a large proportion of whom are low-income and minorities.
"Whether or not it is actual stigmatization is hard to measure, because it's coming from the patients that we interviewed," said UCLA researcher Janni J. Kinsler, the study's project director and lead researcher. "The point is that these people feel that way, and that's bad enough, because they're less likely to seek the care they need."
The study results were based on surveys of 223 HIV-positive individuals in Los Angeles County, with initial baseline interviews taking place between May 2004 and June 2005 and follow-up interviews conducted six months later, from November 2004 to December 2005. Of the respondents, 80 percent were male, 46 percent were African American and 40 percent were Latino. Nearly three-quarters had a high school education or less, half had annual incomes below $8,000 and 46 percent did not have insurance. In addition, 54 percent of the patients reported that they became infected through homosexual contact, 30 percent through heterosexual contact and 16 percent through intravenous drug use.
There are two types of stigma: external, or "public," stigma and personal, or "perceived," stigma. The latter refers to individuals' anticipated fears of societal attitudes or discrimination because their HIV infection.
Researchers questioned 223 patients during the baseline interviews and 171 during the follow-up. They were asked the following questions about stigmatization:
Since you contracted HIV, has any health care provider:
• Been uncomfortable with you"
• Treated you as inferior or in an inferior manner"
• Preferred to avoid you"
• Refused to serve you"
Patients were also asked six questions related to their access to health care: whether they had gone without medical care due to expense, if medical care was conveniently located, whether they could obtain medical care whenever they needed it, if they had easy access to medical specialists, if emergency care was easily obtainable and if they could be admitted to hospitals with no trouble.
The researchers found that at baseline 26 percent of the patients reported at least one of the four types of perceived stigma from a health care provider, and 19 percent reported the same at follow-up. Also, 58 percent claimed low access to care on at least one of the six relevant questions at baseline, as did 57 percent at follow-up.
"Most importantly, we found that those who perceived stigma from a health care provider had more than twice the odds of reporting low access to care, even after examining the effect prospectively and adjusting for a host of sociodemographic and clinical characteristics," the researchers said.
Researchers noted the significance that perceived stigma "could greatly affect [patients'] use of needed medical services, including antiretroviral therapy." Because of this, patients may seek medical care only when their illness has progressed to a more severe stage, leading to more intensive medical interventions, hospitalization and earlier death.
The next step is to investigate whether physicians are in fact stigmatizing these patients, Kinsler said.
In addition to Kinsler, researchers included Mitchell Wong, Jennifer N. Sayles and William Cunningham of UCLA, and Cynthia Davis of Charles R. Drew University of Medicine and Science in Los Angeles.
The U.S. Health Resources and Services Administration, the U.S. Agency of Health Quality Research, the National Center on Minority Health and Health Disparities, and the National Institute on Aging funded this study.