Feelings of stigmatization may discourage HIV patients from proper care
21-Oct-2009 - The feeling of stigmatization that people living with HIV often experience doesn't only exact a psychological
toll -new UCLA research suggests it can also lead to quantifiably negative health outcomes.
In a study published in the October issue of the Journal of General Internal Medicine, researchers from the division of general
internal medicine and health services research at the David Geffen School of Medicine at UCLA found that a large number of HIV-positive individuals who
reported feeling stigmatized also reported poor access to care or suboptimal adherence to antiretroviral therapy (ART).
In fact, individuals who experienced high levels of internalized stigma were four times as likely as those who didn't to
report poor access to medical care; they were three times as likely to report suboptimal adherence to HIV medications.
These findings were due, at least in part, to the poor mental health found among many of the participants. Researchers
found that HIV stigma was one of the strongest predictors of poor access to medical care and that both HIV stigma and poor mental health predicted
suboptimal adherence to medication. Adherence to HIV medications is already known to lead to better health outcomes, including survival, among
people living with HIV.
"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 the study's lead investigator, Dr. Jennifer Sayles, an assistant
professor of medicine at the David Geffen School of Medicine at UCLA and medical director of the Los Angeles County Department of
Public Health's Office of AIDS Programs and Policy.
The study - one of the first to quantify how internalized feelings of stigmatization among people living with HIV negatively influence health
outcomes - is available online at www.springerlink.com/content/71h5331844161x75/fulltext.pdf .
The findings demonstrate the urgent need for more community dialogue, education and
awareness about HIV and the stigma that surrounds the disease, according to 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," Sayles said.
The two-year study focused on 202 HIV-positive men and women in Los Angeles County, many of them minorities and many with limited
incomes and limited education. Study participants completed anonymous surveys assessing internalized HIV stigma, self-reported access to medical
care, their regular source of HIV care and ART adherence.
Overall, one-third of the participants reported experiencing high levels of stigma, and, on average, participants described
experiencing or perceiving stigma slightly less frequently than "some of the time." Additionally, 77 percent of participants said they
had poor access to care, 42.5 percent reported suboptimal adherence to ART and 10.5 percent reported having no regular source of HIV care.
The researchers point to some limitations in the study. They could not establish causality between internalized HIV stigma
and negative outcomes - only a strong association between them. Also, the study did not directly measure social inequality, social
support, self-efficacy and other similar covariates that may be related to HIV stigma. The study may also have missed people
who do not access care or HIV services at all, given that study participants were recruited from community organizations
providing outreach and social services to people living with HIV and from HIV clinical care sites. Finally,
non-English speakers such as Latinos and Asian Americans were underrepresented in the sample.
Study co-authors include Mitchell D. Wong, Janni J. Kinsler and William Cunningham, all of UCLA, and
David Martins of Charles R. Drew University of Medicine and Science.
Grants from the American Foundation for AIDS Research, the California HIV Research Program Network
for AIDS Research in Los Angeles, the National Institute of Mental Health, the National Center on Minority
Health and Health Disparities, and the National Institute on Aging supported this research.
The General Internal Medicine and Health Services Research Division in the department of medicine at the
David Geffen School of Medicine at UCLA provides a unique interactive environment for collaborative efforts between
health services researchers and clinical experts with experience in evidence-based work. The division's
100-plus clinicians and researchers are engaged in a wide variety of projects that examine
issues related to access to care, quality of care, health measurement, physician
education, clinical ethics and doctor-patient communication. Researchers
in the division have close working relationships with economists,
statisticians, social scientists and other specialists
throughout UCLA and frequently collaborate
with their counterparts at the RAND
Corp. and the Charles Drew
University of Medicine and Science.
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