Perceived Discrimination Among Severely Disadvantaged People with HIV Infection

This study explored patient characteristics associated with perceived discrimination within the health care system. The study recruited 523 HIV-infected primarily African-American and Latino people from temporary housing facilities in the New York City area. Participants were interviewed through audio computer-assisted self-interviewing technology. Discrimination, or the perception of it, may discourage patients from seeking treatment, disclosing risk behaviors and maintaining contact with HIV service systems. In order to minimize these effects, it is important to understand the type, source and consequences of discrimination faced by HIV patients.

Nearly 40 percent of participants reported at least one form of discrimination from a member of the health care system. Forms of discrimination included hostility/lack of respect, not giving adequate attention to patient, and refusal of services. Twelve percent reported one type, 17.2 percent reported two types and 10.2 percent reported all three types. The most common explanation given to explain the discriminatory behavior was HIV infection itself. Other common explanations were drug use, homelessness, race/ethnicity or a combination of these attributes. Gender and sexual orientation were infrequently cited as causes of discrimination. Health care providers were less often cited as acting discriminatorily (46.6% of respondents) than were nonproviders (78.6% of respondents). Nurses and medical support staff were considered nonmedical providers. Being female, younger, Causasian, having a high school education, a longer time since testing positive, worse self-reported health status, and nonprescription opioid use were all associated with a higher likelihood of perceived discrimination.

The finding that HIV-infected drug users experience more discrimination and different treatment patterns indicates that this population requires closer attention to the way their HIV treatment is delivered. Fragmentation of health care services may particularly contribute to this phenomenon. Thus, physicians and other providers must be "adept at developing a strong therapeutic alliance" with these patients. While this study cannot attribute causality or directionality to these findings—that patients experiencing discrimination reported greater mistrust in the HIV care system and inadequate access to health care— they indicate the need for a better understanding of pathways linking these associations.