1. Believed discrimination occurred because of their:
Discrimination in Healthcare Settings among HIV-Infected Adults in Care, United States,
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 (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 (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 (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
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 (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)
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