Feelings of Stigmatization May Discourage HIV Patients From Proper Care
October 29, 2009
HIV patients who experience or perceive disease-related stigma were four times as likely as those who did not to report poor access to medical care in a recent study. Individuals who felt "internalized stigma" were also three times as likely to report suboptimal treatment adherence, though mental health mediated the relationship.
In the study, researchers with the University of California-Los Angeles David Geffen School of Medicine analyzed data from anonymous questionnaires submitted by 202 HIV-positive men and women in Los Angeles County.
"We were surprised to find that in our models, experiencing high levels of internalized HIV stigma was one of the strongest predictors of poor access to medical care, even after controlling for sociodemographics such as gender, race and ethnicity, income, insurance status, and clinical variables such as T-cell count and years since HIV diagnosis," said lead author Dr. Jennifer Sayles, an assistant professor of medicine at the school.
On average the participants, many of whom were low-income minorities with limited education, experienced or perceived stigma less frequently than "some of the time." One-third reported high levels of stigma. Of the patients, 77 percent said they had poor health care access, and 10.5 percent reported having no regular source of HIV care. Suboptimal treatment adherence, taking ARVs less frequently than instructed during the last week, was reported by 42.5 percent.
The study suggests a need for further community dialogue, education, and awareness about HIV and disease-related stigma, said Sayles. "It also highlights the need to address some of the social and contextual aspects of HIV for those living with the disease and to develop interventions that reduce internalized HIV stigma as a barrier to care and treatment," she said.
The full report, "The Association of Stigma With Self-Reported Access to Medical Care and Antiretroviral Therapy Adherence in Persons Living With HIV/AIDS," was published in the Journal of General Internal Medicine (2009;doi:10.1007/s11606-009-1068-8).
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.