title: Perceived discrimination among severely disadvantaged people with HIV infection.
abstract: OBJECTIVE
  Studies continue to document that people with human immunodeficiency virus (HIV) experience discrimination in their interactions with the health-care system, which can have negative implications for maintaining continuity in care and outcomes. We explored the patient characteristics associated with perceived discrimination and whether these experiences are associated with health-care system quality ratings in a survey of severely disadvantaged people with HIV who are at great risk of inconsistent access to appropriate health care.
  
  
  METHODS
  Five hundred and twenty-three participants were recruited from temporary housing facilities for people with HIV in the New York City area and administered a survey using audio computer-assisted self-interviewing technology.
  
  
  RESULTS
  Of the 207 participants (39.6%) who reported experiencing discrimination in the health-care system, the most common attributions were HIV infection (n = 122, 59.8%), drug use (n = 100, 49.8%), homelessness (n = 71, 34.6%), and race/ethnicity (n = 69, 35.2%). Length of time HIV infected, use of non-prescription opioids, white race, higher education, female gender, younger age, and poorer self-reported health status were all significantly associated with greater odds of perceived discrimination. After adjusting for participant characteristics, perceived discrimination was significantly associated with poorer participant ratings of quality of health care.
  
  
  CONCLUSIONS
  Members of this vulnerable population commonly report experiences of discrimination from within the health-care system and these experiences are associated with poor health-care ratings. These findings support the need for closer examination of the adequacy of cultural competency training within the HIV health-care delivery system to improve access to appropriate care for disadvantaged people.
authors.affiliation: Sophie Davis School of Biomedical Education, City University of New York, 138th St. and Covent Ave., City College Campus, New York, NY 10031, USA. nsohler@montefiore.org
authors.forename: Nancy
authors.initials: N
authors.lastname: Sohler
authors.forename: Xuan
authors.initials: X
authors.lastname: Li
authors.forename: Chinazo
authors.initials: C
authors.lastname: Cunningham
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D005260:Female; D015658:HIV Infections / Q000208:ethnology / Q000523:psychology* / Q000628:therapy*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006630:Hispanic or Latino; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011203:Poverty; D011287:Prejudice; D011369:Professional-Patient Relations; D012959:Socioeconomic Factors; D035502:Trust; D035862:Vulnerable Populations / Q000523:psychology*