While we have made a number of clinical advances in HIV, stigma remains one of the biggest challenges in ending the epidemic. Stigma is the process, both intentional and unintentional, by which certain groups are devalued through the exercise of power.
Tonia Poteat, Ph.D., M.P.H., PA-C, AAHIVS
Linda Wesp, Ph.D., RN, FNP-C, AAHIVS
People with HIV/AIDS have been marginalized since the virus emerged in the 1980s. Compounding the issue, HIV disproportionately impacts communities that are already experiencing other forms of stigma due to race/ethnicity, sexual orientation, and gender identity.
Studies show HIV-related stigma is associated with poorer mental health, including depression, lower quality of life, lower levels of social support, and poorer self-rated general health. In addition, people who experienced HIV-related stigma are 21 percent less likely to access or use health and social services, and 32 percent less likely to adhere to antiretroviral therapy. Advances in clinical therapies mean nothing if someone is too ashamed to go see a healthcare provider.
Healthcare’s impact
Once diagnosed with HIV, it is recommended to begin treatment immediately. However, if the initial office visit proves to be a negative experience because the person feels judged or stigmatized, the opportunity to keep the person in care may be lost.
Compassionate healthcare providers are an essential component of the support systems of people with HIV. Non-judgmental attitudes from healthcare workers are fundamental to creating a safe space for people with HIV. Supportive attitudes facilitate care-seeking behaviors, motivate adherence, encourage communication, and decrease social isolation and exclusion.
Truly reducing stigma within HIV care settings requires consideration of how structural stigma works to impact our interpersonal interactions. A healthcare provider has to maintain vigilant awareness about their own implicit biases and prejudices. Self-awareness is essential.
To do this, healthcare providers should closely examine their reactions and interactions with individuals from marginalized populations. To ensure patient satisfaction, consider a short clinic assessment survey asking patients if they felt respected during their visit, if their questions were answered, and if they feel comfortable with the provider they were assigned.
Institutional change
It’s also important to review institutional policies and procedures that adversely impact people who are already marginalized.
For instance, consider the information gathered in medical charting and ask if certain information is necessary. Many providers were taught to chart chief complaints such as, “African American female presents with a sore throat.” Research has demonstrated providers’ unconscious bias based on a patient’s skin color, such as presuming that people of color have a higher pain tolerance, and thus providing less pain medication or underdiagnosing serious illnesses.
In this case, is the patient’s skin color relevant? If not, remove the opportunity to have unconscious bias.
In the same vein, a clinic may want to request more information to make the patient feel seen and respected. Asking for a person’s chosen pronouns can be a welcoming sign to a patient who is transgender or non-binary.
Once we notice the ways potential marginalization can occur, we can begin to change them. We won’t be able to end the epidemic without addressing stigma.