United States: Perceived Everyday Racism, Residential Segregation, and HIV Testing Among Patients at a Sexually Transmitted Disease Clinic

More than 25 percent of Americans with HIV remain undiagnosed, the researchers noted. The proportion of diagnoses among blacks is increasing, and blacks may obtain HIV testing at higher rates than do other racial/ethnic groups, according to surveys. In the current study, the authors sought to determine whether perceiving everyday racism, the extent to which individuals were aware of potentially negative routine interactions that reflected racism in their social environment, influences HIV testing behavior.

The study enrolled 373 black patients who sought STD diagnosis or screening in a public clinic in North Carolina. An audio-tape assisted questionnaire assessed perceived racism, coping mechanisms for stress, patient demographics, and items such as perceived risk and HIV knowledge. Researchers used logistic regression and generalized estimating equations for estimating associations.

Among participants, perceived risk of HIV infection was low across ages and genders. More than 90 percent of participants perceived racism, which was associated with higher odds of HIV testing (odds ratio=1.64; 95 percent confidence interval=1.07, 2.52), after controlling for residential segregation and other covariates. Patient satisfaction and stress coping mechanisms did not explain the association.

"Previous research linking perceived racism to attitudes has suggested it may negatively influence behavior," the authors wrote. However, there may be contexts in which an awareness of everyday racism is not inherently detrimental but "health protective," they posit.

"Blacks are not merely victims of racism but also exercise agency within and regarding their social contexts. Those who perceive everyday racism may draw on health-promoting assets relative to their behaviors. We recommend that practitioners work closely with this population to identify transferable, health-protective skills to promote preventive behavior among other blacks," the authors suggested. "Perceived racism may improve the odds of early detection of HIV infection in this high-risk population," they concluded. "For residents of more segregated areas who may be less likely to obtain clinic-based HIV testing, outreach may prove to be effective among this population."

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