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It’s important that HIV care is individualized and representative of a diverse patient population

Understanding HIV stigma

Enacted stigma

  • Patient has past experiences of discrimination, devaluation, and prejudice due to their HIV-positive status1

Anticipated stigma

  • Patient has expectations of repercussions in the future and believes they will be treated negatively by their family, friends, healthcare workers, and/or their community because of their HIV-positive status1

Internalized stigma

  • Patient accepts negative societal characterizations, labels, and perceptions about PLWH and applies these to themself. Internalized stigma is often associated with shame, embarrassment, and low self-worth1

Perceived community stigma

  • Community stigma is often mediated and amplified by internalized stigma. Stigmatizing attitudes may exist in that patient’s community and are perceived as severe1

Stigma and its potential to delay access to care

  • Perceived stigma from providers is associated with lower access to care and greater likelihood of missing doctors’ appointments2
  • People living with HIV who perceive stigma from others, in general, are also more likely to miss clinic appointments for HIV care2
  • Not accessing care could help individuals conceal their HIV status. Additionally, internalized stigma is associated with decreased access to care2

Patients who are experiencing stigma may require social support, counseling, and a connection to care in a supportive practice.1

Addressing stigma may help improve the time from diagnosis to linkage in care and access to treatment. See how treating ASAP can benefit your patients.2

 

Effects of HIV-related stigma

8 out of 10 people highlighted.

According to the CDC, nearly 8 in 10 HIV patients in the US report feeling internalized HIV-related stigma, which may lead to3:

Mental health issues

  • Greater internalized negative feelings about HIV are more likely to cause depressive symptoms, potentially leading to lower visit adherence, engagement, and care1

Racial/ethnic disparities in care

  • HIV disproportionately affects specific populations, communities, and geographic areas within the US. Disparities in access to care exist among men who have sex with men, especially Black, Latino, and American Indian/Alaska Native men4
  • Social factors of health, including poverty, lack of health insurance, income inequality, food insecurity, and unemployment can negatively affect HIV-related health outcomes and transmissions for racial and ethnic minorities5

Underrepresentation within clinical trials

  • Stigma affects whether patients feel comfortable sharing their HIV status, which can cause hesitancy to participate in HIV-related clinical trials6
  • There remains a clear need for culturally and linguistically diverse recruitment and retention to address the barrier of HIV stigma6

Medical mistrust

  • It’s imperative to address the complex relationship that racial and ethnic minorities have with the healthcare system during the creation of HIV clinical trials6

 


How do stigma and underrepresentation cause barriers to HIV care?

DHHS guidelines

  • The time from diagnosis to linkage to care can be affected by stigma and insufficient socioeconomic resources7
  • Patients who experience stigma or who feel judged may not trust a provider’s recommendations, may have lower retention in care, and, consequently, have poorer health outcomes7

FDA guidance on HIV clinical trial design

  • Trials should include adequate US patient representation, which includes an adequate representation of males and females, races, ages, and weights8
  • The inclusion of a diverse patient population early in drug development can help identify potential efficacy or safety issues across a wide range of patients8

A rigorously evaluated regimen may help tailor your treatment plan to specific patient populations. Consider prioritizing patient-centricity and deliver HIV care with sensitivity and persistence.7

See how treating ASAP may benefit your patients.

CDC, Centers for Disease Control and Prevention; DHHS, US Department of Health and Human Services; PLWH, people living with HIV.

References:

  1. Turan B, Budhwani H, Fazeli P, et al. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychologic outcomes. AIDS Behav. 2017; 21(1)283-291.
  2. Earnshaw V, Bogart L, et al. Stigma and racial/ethnic HIV disparities: Moving toward resilience. Amer Psych. 2013;68(4):225-236.
  3. Centers for Disease Control and Prevention. Internalized HIV-related stigma. Published February 2018. Accessed February 7, 2022. https://www.cdc.gov/hiv/pdf/statistics/mmp/cdc-hiv-internalized-stigma.pdf
  4. Centers for Disease Control and Prevention. National HIV/AIDS strategy for the United States. Updated December 12, 2021. Accessed March 3, 2022. https://npin.cdc.gov/publication/national-hivaids-strategy-united-states-2022-2025
  5. American Psychological Association. HIV/AIDS and socioeconomic status. Accessed February 7, 2022. https://www.apa.org/pi/ses/resources/publications/hiv-aids
  6. Bass S, D'Avanzo P, Alhajji M, et al. Exploring the engagement of racial and ethnic minorities in HIV treatment and vaccine clinical trials: A scoping review of literature and implications for future research. AIDS Patient Care and STDs. 2020;34(9):399-416.
  7. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. Updated January 20, 2022. Accessed January 31, 2022. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/guidelines-adult-adolescent arv.pdf
  8. US Food & Drug Administration. Human immunodeficiency virus-1 infection: developing antiretroviral drugs for treatment. Published November 2015. Accessed February 7, 2022. https://www.fda.gov/media/86284/download