270569 HIV stigma as a barrier to testing: Pacific AIDS Education and Training Center's (PAETC) project with clinical providers in low resource settings

Monday, October 29, 2012 : 2:45 PM - 3:00 PM

Nancy Warren, MPH , Pacific AIDS Education and Training Center, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
Mona Bernstein, MPH , Pacific AIDS Education and Training Center, Department of Family and Commuity Medicine, University of California, San Francisco, San Francisco, CA
Issues: Low-resource, low HIV prevalence communities in Federal Region 9 continue to have low rates of HIV screening. Despite state and federal promotion of HIV testing, clinicians in these communities have not embraced HIV screening due, in part, to stigmatized views of people living with HIV (PLWH). Yet instruments to research this stigma among clinicians are outdated or focus on international settings. Description: In a series of 4 focus groups PAETC conducted over 2 years in California's Central Valley, the California/Arizona border with Mexico, and the U.S. Pacific Jurisdictions, clinician participants identified clinical providers' HIV stigma as one of the greatest barriers to HIV testing. Participants described stigma based on socio-demographics including sexual orientation, gender identity and substance use. Participants also reported a “new” stigma: a perception that PLWH will drain clinic resources, resulting in provider reluctance to HIV test. Clinical providers also associated discussions of sex or drugs as overly time intensive. Lessons learned: A search for validated surveys to further explore this issue uncovered surveys that were mostly outdated or focused on clinicians in Africa and Asia with very few questions appropriate for the current US context. US clinicians were assumed to be "over" HIV-related stigma, but our focus groups strongly suggested the opposite. PAETC developed an instrument that included questions on previously missing topics, which emerged out of the focus groups. Recommendations: Developing a relevant stigma questionnaire is necessary to assess and address clinician stigma in low-resource, low prevalence communities to ensure successful routine HIV testing.

Learning Areas:
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public

Learning Objectives:
Describe why assessing and addressing HIV stigma among clinical providers is an important component of implementing routine HIV screening. Design an HIV-related stigma scale relevant to their clinical context.

Keywords: HIV/AIDS, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the evaluator for the Pacific AIDS Education and Training Center since 2009 and since that time have identified and developed a stigma questionnaire to assess and address stigma at our clinics. I have over 20 years working with clinical providers as part of federally funded grants to train and assess HIV skills among clinicians, including a new telehealth grant to provide education to low-volume, low resource clinicians in geographically isolated California communities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.