142nd APHA Annual Meeting and Exposition

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Institutional and structural barriers to HIV testing: Elements for a theoretical framework

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 2:45 PM - 3:00 PM

Beth Meyerson, MDiv, PhD , Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN
Priscilla Barnes, MPH, PhD, MCHES , College of Health and Human Services, Western Michigan University, Eagle River, AK
Roberta Emetu, MLS , Applied Health Science/School of Public Health-Bloomington, Indiana University, Bloomington, IN
Marlon Bailey, PhD , Department of Gender Studies, Indiana University, Bloomington, IN
Anita Ohmit, MPH , Racial and Ethnic Minority Epidemiology Center, Indiana Minority Health Coalition, Indianapolis, IN
Anthony Gillespie , Indiana Minority Health Coalition, Indianapolis, IN
Audio (mp3) recording Recorded Presentation (mp4)
Background: Stigma is a barrier to HIV health seeking, but little is known about institutional and structural expressions of stigma in HIV testing. While stigma is likely expressed institutionally or organizationally, it is a bit like fog: seen by everyone, palpably experienced by many, but difficult to study. This study examines evidence of institutional and structural stigma in the HIV testing process.

Methods: A qualitative, grounded theory study was conducted using secondary data from a 2011 HIV test site evaluation data in a Midwestern, moderate HIV incidence state.  

Results: Expressions of structural and institutional stigma were found with over half of the testing sites and at three stages of the HIV testing visit. Examples of structural stigma included social geography, organization and staff behavior at first encounter and reception, and staff behavior when experiencing the actual HIV test. Institutional stigma was socially expressed through staff behavior at entry/reception and when experiencing the HIV test.

Conclusions: The emerging elements demonstrate the potential compounding of stigma experiences with deleterious effect.  Study findings may inform future development of a theoretical framework. In practice, findings can guide organizations seeking to reduce HIV testing barriers, as they provide a window into how test seekers experience HIV test sites at first encounter, entry/reception and at testing stages; and can identify how stigma might be intensified by structural and institutional expressions.

Learning Areas:

Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe institutional and structural elements of stigma identified in HIV testing services Identify the compounding impacts of stigma in the testing visit itself Discuss opportunities for system and services improvements

Keyword(s): HIV/AIDS, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Meyerson has led several studies in HIV prevention and testing with focus on community access and participatory research. She is Co-Director of the Rural Center for AIDS/STD Prevention at Indiana University School of Public Health-Blooomington and was formerly president of Policy Resource Group, LLC a firm specializing in HIV and STD policy and systems research.
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.

Back to: 4331.0: Structural and Institutional Issues in HIV/AIDS