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Study: Healthcare Discrimination Linked to Suboptimal HIV Medication Adherence in Women

To achieve optimal viral suppression, people living with HIV should take at least 95% of medication doses on a regular basis. Women who perceive discrimination in healthcare settings are 19% less likely to report optimal adherence to HIV treatment regimens, according to a study recently published in the journal AIDS and Behavior.

Over one quarter of people living with HIV in the U.S. report being discriminated against by a healthcare employee since becoming positive. Discrimination in this context ranges in severity – from stigmatizing behaviors like lack of touch and avoiding eye contact to more overt actions like denying care.

Scientists studying the connection between HIV-related discrimination and poor medication adherence point to the damaging effects of discrimination on mental health, which could explain lower adherence.

“Perceiving discrimination in healthcare settings may contribute to internalization of HIV-related stigma, which in turn may lead to depressive symptoms, with downstream adverse effects on ART adherence among women,” said Bulent Turan, the lead author of the study and Associate Professor of Psychology at the University of Alabama.

Among the 1,356 patients from across the U.S. who participated in the study, 83% were optimally adherent to their HIV medication. Adherence was significantly lower, on average, in younger individuals and those who use illicit drugs. Survey data came from the Women’s Interagency HIV Study at Johns Hopkins University – one of the largest ongoing studies of women living with HIV in the U.S.

Turan recommended that clinical organizations assess their employees’ knowledge of HIV discrimination and implement educational programs where necessary. “Some healthcare institutions may further consider actual evaluation of implicit and explicit HIV-related biases in health care settings,” he Turan.

A previous study conducted in Alabama demonstrated the feasibility of training healthcare professionals and HIV-positive patients to identify and address HIV-related discrimination. Educational programs like the one carried out in Alabama provide healthcare employees with opportunities to examine how their biases might impact their quality of care. For patients, being trained to detect provider biases could help with navigating problematic patient-provider dynamics.

Given the importance of maintaining optimal medication adherence to suppress the virus, study authors emphasized that “much is at stake” when HIV-positive patients perceive discrimination in clinical settings. Indeed, these perceptions may have lasting effects on patients’ mental health and HIV disease progression.

These findings deepen our understanding of HIV-related stigma and discrimination – an area of public health research that has received more serious attention in recent years. Another study published late last year found a statistical connection between experiencing homophobia and acquiring HIV and STIs. Taken together, studies on stigma add nuance to the growing recognition that the social environment may be more critical to physical health than previously understood.