Provider perceptions of how HIV-related stigma might impact testing, treatment and adherence among HIV-positive Latino patients in the U.S.-Mexico border region

Background: HIV-related stigma remains an elusive problem with demonstrated impact on care engagement. There is limited research on how HIV-related stigma affects patients, from the provider's perspective. We conducted a binational qualitative study to explore provider perceptions of how HIV-related stigma impacts their patients' care in the U.S.-Mexico border region.

Methods: We conducted semi-structured qualitative in-depth interviews with 19 HIV health care providers in Tijuana and San Diego (June/2010-January/2011). Transcripts were coded drawing upon principles of Grounded Theory.

Results: Providers from both cities mentioned that HIV-related stigma might influence patients' likelihood to get tested, engage in HIV care and adhere to HIV treatment. Primary themes were: i. self-perceived stigma – providers perceived that some patients do not readily disclose their HIV status and/or fear rejection because of their positive status; and fear being labeled as HIV positive or having AIDS due to observable physical changes. ii. Community stigma- providers suggested that rejection and isolation by family and partners may influence the patient's decision to continue treatment and may negatively influence mental health (e.g. depression). iii. Health provider and work environment stigma- providers reported patient descriptions of discrimination, isolation and rejection in the workplace and non-HIV care settings.

Conclusions: Clinicians caring for a largely binational patient population described multiple instances of patient perceived HIV-related stigma. Fear of being stigmatized at any level, may influence testing behavior and negatively affect patient's willingness to access care. Interventions are needed to reduce structural/social stigma in the work place and community.