title: Linking and retaining HIV patients in care: the importance of provider attitudes and behaviors.
abstract: Retention in HIV treatment may reduce morbidity and mortality, as well as slow the epidemic. Myriad barriers to retention include stigma, homophobia, structural barriers, transportation, and insurance. The purpose of this study was to evaluate patient perceptions of provider attitudes among HIV-infected persons within a state-wide public hospital system in Louisiana. A convenience sample of patients attending HIV clinics throughout the state participated in an anonymous interview. Factors associated with negative perceptions of care were evaluated in conjunction with a validated stigma measure. Factors associated with having a delayed entry into or break in care were evaluated in conjunction with perceived stigma. Between 2/1/09 and 7/31/11, 479 participants were interviewed and had sufficient data available, of whom 53.4% were male, 79.3% were African American, and 29.4% reported a break or delayed entry into HIV care of >1 year. A break in care was associated with perceiving that the doctor or health professionals do not listen carefully most or all of the time (p<0.01), having an elevated stigma score (p<0.05), and indicating that providers dislike caring for HIV-infected people (p<0.01). Women were more likely to have an elevated stigma score than men (p<0.01), as were participants over 30 (p<0.01); those with a gay/bisexual orientation (p<0.05) were less likely to have an elevated stigma score. Those with a break in care were less likely to have Medicaid (p<0.05). Providers play a key role in the retention of HIV-infected persons in care and are critical to improving outcomes and slowing the epidemic. Development of novel approaches to reduce stigma are imperative in improving retention.
authors: Department of Epidemiology/Biostatistics, George Washington University, Washington, DC 20037, USA. manyadm@gwu.edu
authors: Manya
authors: M
authors: Magnus
authors: Jane
authors: J
authors: Herwehe
authors: Michelli
authors: M
authors: Murtaza-Rossini
authors: Petera
authors: P
authors: Reine
authors: Damien
authors: D
authors: Cuffie
authors: DeAnn
authors: D
authors: Gruber
authors: Michael
authors: M
authors: Kaiser
mesh_terms: D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000523:psychology / Q000628:therapy*; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006783:Hospitals, State; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008145:Louisiana; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010352:Patient Dropouts; D010465:Perception; D011369:Professional-Patient Relations; D012737:Sex Factors; D057545:Social Stigma; D012959:Socioeconomic Factors; D055815:Young Adult
references: J Am Med Inform Assoc. 2012 May-Jun;19(3):448-52
references: 22037891
references: AIDS Patient Care STDS. 2007;21 Suppl 1:S40-8
references: 17563289
references: AIDS Behav. 2008 Sep;12(5):748-58
references: 18389363
references: J Acquir Immune Defic Syndr. 2010 Apr;53(5):648-55
references: 19952767
references: AIDS Care. 2009 Jun;21(6):742-53
references: 19806490
references: N Engl J Med. 2011 Aug 11;365(6):493-505
references: 21767103
references: J Gen Intern Med. 2009 Oct;24(10):1101-8
references: 19653047
references: AIDS Patient Care STDS. 2011 Oct;25(10):601-9
references: 21955175
references: Clin Infect Dis. 2007 Jun 1;44(11):1493-9
references: 17479948
references: MMWR Morb Mortal Wkly Rep. 2011 Dec 2;60(47):1618-23
references: 22129997
references: J Urban Health. 2007 Nov;84(6):814-28
references: 17786561
references: PLoS One. 2010 Jun 10;5(6):e11068
references: 20548786
references: BMJ. 2009 Apr 30;338:b1649
references: 19406887
references: Lancet. 2009 Jan 3;373(9657):48-57
references: 19038438
references: AIDS Patient Care STDS. 2007;21 Suppl 1:S77-84
references: 17563293
references: Clin Infect Dis. 2011 Mar 15;52(6):793-800
references: 21367734
references: AIDS. 2008 Aug;22 Suppl 2:S67-79
references: 18641472
references: AIDS Patient Care STDS. 2007 Aug;21(8):584-92
references: 17711383
references: Int J Med Inform. 2012 Oct;81(10):e30-8
references: 22883431