Chronic Discrimination a Barrier to HIV Treatment

Published: May 24, 2011

May 26, 2011 (Miami, Florida) — HIV-infected Latino men who have sex with men and who experience chronic discrimination for a variety of reasons, including their ethnicity and sexual orientation, develop a mistrust of the healthcare system and avoid seeking treatment, researchers reported here at the 6th International Conference on HIV Treatment and Prevention Adherence, sponsored by the International Association of Physicians in AIDS Care (IAPAC).
"Our theory in doing this study was that men who experience a lot of chronic discrimination over time in different areas of their life and in different amounts and intensity would grow to have more medical mistrust of the healthcare system and of public health messages," Laura M. Bogart, PhD, from Children’s Hospital Boston and Harvard Medical School, Massachusetts, told Medscape Medical News.
Constantly being the victim of discrimination "can lead to a suspicion of outsiders, of new treatments, of whether one should listen to what the government is saying or not, and then to not necessarily believing provider recommendations. You may not know who to believe and who to trust," she said.
In this study, Dr. Bogart and her colleagues worked with an organization that serves Latinos living with HIV in Southern California, called Bienestar Human Services.
"These men are a very hidden population. Many of them were undocumented — most were not legal residents of the United States — so we needed to work with a community organization that is well trusted in the community, [with workers] who could relate well to the people who participated in our study," she explained.
Aided by Bienestar, 137 Latino men on antiretroviral treatment completed interviews that measured adherence, medical mistrust and discrimination due to HIV status, race/ethnicity, and sexual orientation.
The researchers found high levels of discrimination. Thirty-eight percent said they had been discriminated against because of their HIV status, 38% because they were Latino, and 47% because of their sexual orientation.
The researchers found that 23% of the men reported they had missed a medication dose on the day before the interview. Greater medical mistrust was significantly associated with nonadherence (odds ratio [OR], 0.37; P < .01).
Also associated with nonadherence were perceived discrimination because of HIV serostatus (OR, 0.78; P < .01), race/ethnicity (OR, 0.82; P < .05), and sexual orientation (OR, 0.82; P < .05).
The study also found that discrimination related to being Latino and being HIV-positive were significantly correlated with medical mistrust.
"When these men were discriminated because they were Latino, it was more likely to affect their adherence. We are not sure exactly why and we are trying to understand the reasons for this," Dr. Bogart said.
Mistrust of the healthcare system often tends to be ignored when it comes to figuring out why people are not adherent to treatment, she added.
"We don’t think about the factors that we can’t see. We think about whether someone can get to the doctor. Do they have transportation? Do they have access to healthcare? We think about these more traditional barriers to healthcare. But what our study is saying is that there may be other barriers to treatment that prevent people from being adherent — barriers that we can’t see that are more cultural, more social, and that we need to pay more attention to," she said.

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