Stigma, Health Discrimination Common for Hispanic Adults With HIV

Reports of stigma and healthcare discrimination run high among Hispanic adults with HIV, according to an analysis of self-reported data from the U.S. in 2018 to 2020.

Of 2,690 people interviewed, the overall median HIV stigma score was 31.7 on a scale of 0 to 100 for this population, with higher median scores among women (35.6 vs 30.3 in men), as well as those who identified as American Indian or Alaska Native (38.9) and those who were born in the Caribbean (35.7), reported researchers led by Mabel Padilla, MPH, of the CDC's National Center for HIV, Viral Hepatitis, STD, and TB Prevention.

Nearly 23% of Hispanic adults with HIV also reported experiencing healthcare discrimination during the previous 12 months, with 8% reporting one experience, 4% reporting two, and 11% reporting three or more, they noted in the Morbidity and Mortality Weekly Report.

Healthcare discrimination was experienced more frequently by men (23%) versus women (18%) and by Black or African-American Hispanic adults (28%) versus white Hispanic adults (21%), Padilla and team said.

"HIV stigma and discrimination are human rights issues associated with adverse HIV outcomes; eliminating stigma and discrimination, which are barriers to HIV care and treatment, is a national priority," they wrote.

"Understanding disparities in experiences of stigma and discrimination is important when designing culturally appropriate interventions to reduce stigma and discrimination," they added.

While HIV stigma was most commonly attributed to disclosure concerns -- "fearing others will disclose one's HIV status and being careful about who one tells about one's HIV status" -- reported by 48% to 78% of participants, 20% to 28% also reported concerns around perceived public attitudes.

Among those who reported experiencing healthcare discrimination, 62% felt that a doctor or nurse was not listening to what they were saying, 48% felt they were treated with less respect than others, and 48% perceived they were treated with less courtesy than others. In addition, 30% attributed this discrimination to their HIV infection, 23% to their sexual orientation or sexual practices, and 20% to their race or ethnicity.

Padilla and team noted that the higher reported prevalence of discrimination among men may be due to sexual orientation discrimination, since more Hispanic men with HIV identify as gay or bisexual compared with women with HIV.

The researchers underscored that eliminating stigma and discrimination would require interventions at multiple levels, including at the person, provider, facility, and community level. "Provider-focused trainings, policies, and practices are needed to address HIV stigma and discrimination experienced by Hispanic persons with HIV," they wrote.

"Trauma-informed approaches to HIV care and treatment might reduce discrimination in HIV care settings by creating feelings of safety, empowerment, and trust among patients while moving beyond cultural biases and stereotypes," they added.

Appropriate interventions can only be designed when disparities are well understood, they noted. "Training for providers should focus on actively listening to patient concerns, including stigma experiences, using culturally and linguistically appropriate methods."

For this analysis, Padilla and colleagues used 2018-2020 data from the CDC's Medical Monitoring Project (MMP), an annual cross-sectional study designed to report nationally representative estimates of experiences and outcomes among adults with HIV.

HIV stigma was measured using an adapted version of a validated 10-item scale that measures four dimensions of HIV stigma:

• Personalized stigma (consequences of other people knowing their status)
• Disclosure concerns
• Negative self-image
• Public attitudes

HIV healthcare discrimination over the previous 12 months was assessed based on seven forms of discrimination, using an adapted version of a validated Likert scale.

Gender, race, Hispanic origin, country or region of birth, and English proficiency were considered in all assessments.

Among the 2,690 people interviewed, 81% were men, 66% identified as white, 13% identified as Black, and 4% identified as American Indian or Alaska Native. Thirty-six percent identified their Hispanic origin as Mexican, Mexican American, or Chicano, and 34% identified as Puerto Rican. Sixty-two percent were born outside the continental U.S., 22% were born in Puerto Rico, and 19% were born in Mexico. Of note, 42% had limited English proficiency.

HIV stigma scores according to Hispanic origin (Mexican, Mexican American, Chicano, Puerto Rican, Cuban, or other) were similar as were scores between people born in the U.S. versus outside the U.S. (median 31.0 vs 32.9).

Padilla and team said their analysis was limited by the self-reported nature of the MMP, meaning the data are subject to recall and social desirability bias. Furthermore, the interviews only captured discrimination in HIV healthcare settings, and excluded those not receiving care, as well as other forms of discrimination.

Comment