AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #62 - Experiences with discrimination in receiving health care: Does HIV infection alone account for greater risk among gay and bisexual men?
Authors: Presenting Author: Prof Vickie Mays - UCLA
Additional Authors: Dr. Susan Cochran,
Aim: HIV-related stigma in health care settings has been well documented (Nyblade, Stangl, Weiss, & Ashburn, 2009). However, for many HIV patients the source of the stigma is rooted in both being a patient with HIV disease and being a member of a marginalized sexual minority. We use data from the population-based California Quality of Life Surveys to investigate the extent to which experiences with health care discrimination vary by both sexual orientation and self-reported HIV infection status among men. We evaluated 3 aspects of discrimination: experiencing a provider acting uncomfortable due to a personal characteristic of the respondent; having a provider make hostile or negative comments due to a personal characteristic of the respondent; or being treated disrespectfully or receiving poorer care due to discrimination.
Method / Issue: The Cal-QOL surveys drew two cross-sectional population-based samples of Californians, age 18 to 72 years, including 2,469 men (1,699 heterosexual; 770 MSM). All were administered a structured interview assessing sexual orientation, perceptions of discrimination in receipt of health care in the prior 12 months, and self-reported HIV status. Nearly 13% of MSM reported prevalent HIV infection; no heterosexually classified man did. We divided the sample into three groups: heterosexual men, HIV-infected MSM, and uninfected MSM. Weighted analyses were used to investigate differences in self-reports of discrimination. All analyses adjusted for possible confounding due to age, race/ethnicity, education, family income, and health insurance status.
Results / Comments: Experiences with health care discrimination were relatively rare. Overall, 3.0% of respondents reported a health care provider acting uncomfortable, 2.1% reported negative comments, and 4.7% reported being discriminated against. However, these rates were significantly elevated among both HIV-positive MSM (12.0%, 5.6%, 12.3%) and HIV-negative MSM (7.9%, 3.6%, 5.6%) as compared to heterosexual men (2.8%, 2.0%, 4.6%). After adjusting for possible confounding, HIV-positive MSM when compared to heterosexual men had significantly greater odds of reporting that a provider had acted uncomfortable (adj OR = 4.74, 95% CI: 2.03-11.04) or that they had been treated disrespectfully (adj OR = 3.50, 95% CI: 1.59-7.72). Experiences with negative or hostile comments, while elevated, did not reach statistical significance (adj OR = 2.70, 95% CI: 0.94-7.73). HIV infection was not the sole cause for these men’s experience with discrimination. Comparisons of uninfected MSM and heterosexual men revealed a similar significant elevation in odds for experiencing a provider acting uncomfortable (adj OR = 3.10, 95% CI: 1.52-6.33).
Discussion: In California, HIV-related stigma, as well as MSM status results in higher rates of perceived discrimination in receiving health care services. Efforts to intervene to reduce difficulties in health care delivery need to target not only HIV-related concerns among medical staff but also possible discomfort with treating MSM.
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