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

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 Yet instruments to research this stigma among clinicians are outdated or focus on international settings.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 Lessons learned: A search for validated surveys to further explore this issue uncovered surveys that were mostly outdated or focused on clinicians in Africa and Asia with very few questions appropriate for the current US context.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.