Perceived discrimination in clinical care in a nationally representative sample of HIV-infected adults receiving health care.
BACKGROUND
Perceived discrimination in clinical settings could discourage HIV-infected people from seeking health care, adhering to treatment regimens, or returning for follow-up.


OBJECTIVE
This study aims to determine whether HIV-infected people perceive that physicians and other health care providers have discriminated against them.


METHODS
Cross-sectional data (1996 to 1997) from the HIV Cost and Services Utilization Study (HCSUS), which conducted in-person interviews with a nationally representative probability sample of 2,466 HIV-infected adults receiving health care within the contiguous U.S.


METHODS
Reports of whether health care providers have been uncomfortable with the respondent, treated the respondent as an inferior, preferred to avoid the respondent, or refused the respondent service. Questions also covered the types of providers who engaged in these behaviors.


RESULTS
Twenty-six percent of HIV-infected adults receiving health care reported experiencing at least 1 of 4 types of perceived discrimination by a health care provider since becoming infected with HIV, including 8% who had been refused service. White respondents (32%) were more likely than others (27%) and Latinos (21%) and nearly twice as likely as African Americans (17%) to report perceived discrimination (P < .001). Respondents whose first positive HIV test was longer ago were also more likely to report discrimination (P < .001). Respondents who reported discrimination attributed it to physicians (54%), nurses and other clinical staff (39%), dentists (32%), hospital staff (31%), and case managers or social workers (8%).


CONCLUSIONS
Many HIV-infected adults believe that their clinicians have discriminated against them. Clinicians should make efforts to address circumstances that lead patients to perceive discrimination, whether real or imagined.
Schuster
Mark A
MA
RAND, Santa Monica, CA 90407-2138, USA. schuster@rand.org
Collins
Rebecca
R
Cunningham
William E
WE
Morton
Sally C
SC
Zierler
Sally
S
Wong
Myra
M
Tu
Wenli
W
Kanouse
David E
DE
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000208:ethnology / Q000523:psychology*; D006297:Health Services Accessibility; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011287:Prejudice; D011787:Quality of Health Care; D035502:Trust; D014481:United States; D044465:White People