142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Stigma as barrier to HIV testing: Measuring primary care clinicians' level and type of HIV stigma

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 11:00 AM - 11:15 AM

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
Michael Reyes, MD, MPH , Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA

Stigma remains a major barrier to increasing HIV testing in healthcare settings, despite years of government effort since the CDC 2006 revised recommendations for routine screening.  However,  few recent surveys have been implemented to gauge US healthcare provider-level HIV-related stigma.


The Pacific AIDS Education & Training Center (PAETC) conducted an anonymous self-reported clinic staff survey in low HIV prevalence areas in  California, Nevada, and Arizona, including American Indian reservations in Arizona and Nevada, and California and Arizona’s border with Mexico. Questions used a 4-point Likert scale; bivariate analysis was conducted (STATA).

Lessons Learned:

The sample (N=126) included prescribing clinicians (87), non-prescribing clinicians (23) and other clinic staff (16); mean age was 45. Ethnicity included Caucasian (52.3%) Latinos (17%), and African Americans (6.4%). Most respondents were heterosexual (97%) and female (69%); 64% worked at Community Health Clinics; 19% at public health clinics; and 10% at Tribal Health Clinics. Prescribers were more likely than non-prescribers to describe HIV+ people as irresponsible, (p=.02) to believe having religious beliefs reduces HIV risk (p=.04); to believe that coworkers didn’t want to treat transgender patients (p=.03) or drug abusing patients (p=.009), and MDs believed that HIV patients require more time than other patients (p=.04). Over 40% agreed or strongly agreed that HIV+ women should not get pregnant.


That this sample’s prescribers had such negative views of HIV patients indicates the need for education with clinicians and further study of how stigma among healthcare providers remains a barrier to HIV testing and care.

Learning Areas:

Advocacy for health and health education
Assessment of individual and community needs for health education
Chronic disease management and prevention
Diversity and culture
Provision of health care to the public

Learning Objectives:
Explain what demographic characteristics appear to be associated with negative perception of patients who are HIV+ or presumed to be at risk in this sample. Describe clinician's opinions of HIV+ women and pregnancy in this sample. Identify the areas in which this sample's prescribers appear to hold negative views of HIV positive patients.

Keyword(s): HIV/AIDS, Health Disparities/Inequities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working as a researcher and evaluator in HIV-focused programs for over 20 years, including HRSA and CDC grants. I have focused on vulnerable groups ability to access HIV care including multiple qualitative and quantitative evaluations assessing primary care clinician's HIV stigma, to understand how this impacts their ability to implement routine HIV testing and care. I wrote one of the first papers on HIV+ jail inmates difficulty accessing clinical care upon release.
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: 4136.0: Stigma and HIV/AIDS