Believed discrimination occurred because of their: Discrimination in Healthcare Settings among HIV-Infected Adults in Care, United States, 2011-2013 Amy R. Baugher, MPH1; Linda Beer, PhD1; Jennifer L. Fagan, MA1; Christine L. Mattson, PhD1; Mark Freedman, DVM, MPH1; and R. Luke Shouse, MD, MPH1 for the Medical Monitoring Project 1Centers for Disease Control and Prevention BACKGROUND HIV-related discrimination may be complicated by stigma related to characteristics and behaviors (e.g., HIV status, gender, sexual orientation, race/ethnicity, injection drug use) Discrimination in healthcare settings has been associated with poor health outcomes, low healthcare utilization, and poor HIV treatment adherence National estimates are needed to measure progress towards goal of decreasing discrimination set by the National HIV/AIDS Strategy Understanding perceived reasons for discrimination could help inform discrimination reduction interventions RESULTS 23.4% of HIV-infected adults in care reported discrimination in a healthcare setting at any time since diagnosis Discrimination was more frequently reported by respondents who were non-Hispanic white, Hispanic/Latino, older, homosexual, had public or private insurance, or were diagnosed ≥5 years ago Most respondents attributed discrimination to HIV status Sexual, gender, and racial minority groups were likely to attribute discrimination to their minority status in addition to their HIV status Table 1. Self-reported discrimination in a healthcare setting experienced by HIV-infected adults since receiving diagnosis, MMP 2011-2013 (n=14,341)   n Weighted % (95%CL) Has anyone in the healthcare system done any of the following to you since testing positive for HIV? Exhibited hostility or a lack of respect toward you? 2868 20.2 (18.4, 22.0) Given you less attention than other patients? 1989 14.3 (12.8, 15.8) Refused you service? 1077 7.5 (6.8, 8.2) Reported any discrimination 3336 23.4 (21.4, 25.5) Table 2. Self-reported discrimination among HIV patients, by demographic factors and insurance type, MMP 2011-2013 (n=14,341) n Weighted % (95%CL) reporting discrimination p-value Gender Male 10288 23.2 (20.9, 25.5) Ref Female 3845 23.8 (21.9, 25.6) 0.43 Transgender 200 27.8 (19.4, 36.3) 0.29 Race/ethnicity Black, non-Hispanic 6018 17.6 (15.8, 19.3) Hispanic or Latino 3163 20.9 (19.1, 22.6) <0.0001 White, non-Hispanic 4527 30.7 (28.3, 33.1) Other 633 34.3 (30.3, 38.3) Age (years) 18-29 1070 15.9 (12.4, 19.3) 30-39 2155 20.9 (18.6, 23.3) 0.63 40-49 4610 25.2 (22.7, 27.7) ≥50 6506 24.3 (22.2, 26.4) 0.0001 Sexual orientation Homosexual 5884 26.1 (23.7, 28.5) Heterosexual 7111 20.9 (19.1, 22.8) Bisexual 1157 22.7 (19.3, 26.2) 0.24 189 33.4 (26.3, 40.6) 0.0004 Insurance Private 4022 24.1 (21.6, 26.6) Public 7931 25.5 (23.0, 28.0) Ryan White/Uninsured 2346 16.2 (14.3, 18.0) Time since diagnosis <5 years 2801 14.2 (12.5, 15.9) ≥5 years 11537 25.9 (23.6, 28.1) Figure 1. Perceived reasons for discrimination among HIV patients reporting any discrimination, MMP 2011-2013 (n=3,336) LIMITATIONS Reasons for discrimination based on patient perceptions Unknown if discrimination occurred recently Frequency and intensity of discriminatory experiences were not measured Since discrimination can affect retention, we may underestimate discrimination as respondents in sample are in care OBJECTIVES To describe prevalence of self-reported experiences of discrimination in healthcare settings among HIV-infected adults in care, overall and by characteristics To describe respondent’s perception of characteristics associated with the discrimination CONCLUSIONS Discrimination in a healthcare setting was reported by nearly one quarter of respondents Since discrimination can negatively affect treatment adherence and retention, efforts to address discrimination may improve health outcomes For minority groups, discrimination may be multifactorial; efforts to decrease healthcare discrimination may need to address these factors in addition to HIV METHODS The Medical Monitoring Project (MMP) is a supplemental surveillance system designed to produce nationally representative estimates for HIV-infected adults receiving HIV care in the U.S. We combined interview data from three data collection cycles from 2011-2013 Facility response rates: 83-85% Patient response rates: 49-55% Discrimination defined as ≥1 discriminatory experiences in a healthcare setting since HIV diagnosis (Table 1) Respondents reporting any discrimination since diagnosis were asked which characteristics and behaviors they believe were the reason for discrimination: HIV status, gender, sexual orientation, race/ethnicity, and/or injection drug use We assessed differences in discrimination using bivariate analyses (p<0.05) of weighted estimates, accounting for clustering, unequal selection probabilities, and non-response *Respondents could select more than one reason Table 3. Perceived reasons for discrimination by subgroups (weighted row % (95% CL), MMP 2011-2013 (n=3,336) Believed discrimination occurred because of their: Gender Sexual orientation Race/ethnicity Injection drug use Male 9.2 (7.6, 10.9) Homosexual 50.1 (46.2, 54.1) Black, non-Hispanic 21.5 (17.8, 25.3) Injected drugs in past 12 months 35.6 (26.7, 44.5) Female 7.3 (5.6, 9.1) Heterosexual 6.4 (5.0, 7.8) Hispanic or Latino 18.1 (13.1, 23.1) Did not inject drugs in past 12 months 4.2 (3.4, 5.0) Transgender 46.0 (32.1, 59.9) Bisexual 38.8 (30.9, 46.6) White, non-Hispanic 3.8 (2.5, 5.1) - Other 49.8 (34.4, 65.3) 18.4 (11.7, 25.2) Total 9.3 (8.0, 10.7) 29.6 (26.2, 33.1) 12.8 (11.1, 14.4) 5.1 (4.1, 6.2) ACKNOWLEDGEMENTS We thank MMP participants, facilities, and staff; the Community and Provider Advisory Boards; and the Clinical Outcomes Team for their contributions. MMP is funded by the CDC. CONTACT Amy Baugher, MPH Health Scientist (404)-639-1956 abaugher@cdc.gov Members of racial/ethnic, gender, and sexual minority groups were more likely to attribute healthcare discrimination to these statuses in addition to their HIV status Division of HIV/AIDS Prevention