Provider-centric stigma reduction interventions can help reduce stigmatizing behaviors towards patients with HIV and potentially improve care, according to a new systematic review from the CDC.
Despite national progress in treating the disease and preventing transmissions, HIV-related stigma remains a primary barrier to individuals seeking care services. According to the report, HIV-related stigma has been associated with decreased testing, condom use, pre-exposure prophylaxis (PrEP) uptake, medication adherence, linkage to care, and retention in care.
Although previous studies have focused on patients’ perspectives of stigma, there is limited evidence regarding the perspectives of health care providers. In the review, researchers from the CDC examined stigmatizing factors among health care providers that may impede a patient’s care. From an analysis of 619 studies published between 2010 and 2017, the authors identified 3 themes:
1. Attitudes, beliefs, and behaviors
2. Quality of patient care
3. Education and training
According to the review, stigmatizing behaviors, attitudes, and beliefs varied by gender, race, religion, provider category, and clinical setting. The findings suggested that patients are often stigmatized as being poor, having a high number of sexual partners, and frequently engaging in other risky sexual behavior. HIV-related stigma was less likely among providers who worked in settings in which policies focused on HIV-related stigma were reinforced, according to the report.
Stigma can manifest through inadvertent behaviors and ideologies, the authors noted. More overt HIV-related stigma can include providers who take extreme precautionary measures during routine examinations, use of stigmatizing language, and even denial of necessary services or treatment.
The authors also investigated how provider stigma could affect patient care. The analysis showed that provider fear of acquiring HIV through occupational exposure led to reduced quality of care, refusal of care, and anxiety when providing services to patients.
“Moreover, patient-provider discordance in the prioritization of addressing HIV-related stigma over other health care needs led to reduced quality of care or patient satisfaction,” the study authors wrote.
Additionally, provider education appeared to affect attitudes, with lower rates of stigma among health care providers who received HIV stigma training in the past 12 months. For non-HIV specialty clinicians, the researchers noted that there were limited opportunities for clinical education.
Overall, the researchers reported that stigma can create a barrier to HIV prevention, treatment, and care. Increased provider education and awareness could potentially improve patient access to services and outcomes. Policies, such as opt-out HIV testing, can reduce stigma by normalizing testing and removing risk-based screening practices, they added.
“Given the disproportionate burden of HIV-related stigma in the United States, the development of interventions that decrease healthcare provider stigma, increase health care provider awareness of stigma, and establish the presence of clinical policies to address HIV-related stigma are warranted,” the authors concluded.
By Jennifer Barrett
Geter A, Herron AR, Sutton MY. HIV-Related Stigma by Healthcare Providers in the United States: A Systematic Review. AIDS Patient Care and STDs. 2018. https://doi.org/10.1089/apc.2018.0114