August 3, 2011
Doctors shy away from testing because of stigma. Credit: MadameNoire.com.
A recent survey revealed that African-American doctors do not routinely test for HIV because of stigma. The study, commissioned by Janssen Pharmaceuticals, finds that although African-American doctors are concerned about HIV among their patients many of them only tested about one-third of them within the past year.
African-American physicians cited that social stigma keeps them from routinely testing their patients. The study results showed that doctors feel that testing every patient seems judgemental and offensive. Dr. Lisa Fitzpatrick, Infectious Disease physician at United Medical Center in Southeast and appointee to the Mayor's Commission on AIDS, says it's not just African-American doctors who are stumped by stigma. "I think physicians across the spectrum have pre-conceived ideas about who is HIV infected and who's not. I think providers still believe that they can decide who needs an HIV test and who doesn't. A lot of providers are still doing risk-based testing because they think HIV only happens in certain populations. We want all healthcare providers to routinely screen for HIV, especially in DC where we have such a high prevalence of HIV."
This survey also brings back up the debate about routine based testing versus risk based testing. Those who are against routine testing feel that it is costly and unnecessary to test everyone for HIV when they are not at high risk for infection. Should a 32 year-old married mother continue to get tested for HIV if she is only sexually active with her faithful husband? Questioning her sexual habits and planting seeds of doubt in her head about her husband's activities can be stressful and may cause friction within the doctor-patient relationship. Routine testing also assumes that a patient sees a doctor regularly or will have access to testing. For example, is it realistic to think that a chronically homeless man who is barely eating regular meals will put health care screenings at the top of his to-do list? Perhaps not.
Doctors from the study offered solutions such as placing more patient-focused literature in their waiting rooms, more media attention on the importance of testing, and having a government mandate in place to force them to test more often. One way to reduce stigma is to keep HIV testing at the forefront of medical care for all doctors. Keeping HIV visible will help ease the shame and embarassment of having a test performed. Dr. Fitzpatrick says this is the best way to reduce stigma. "If this becomes a standard of care across the board then this will become as common as getting your cholesterol checked or blood pressure checked. I think this is the way to go because patients will start to see that this is a treatable, chronic disease and that no one is being singled out."
Dr. Fitzpatrick is also on the faculty at Howard University.