Bird Sheryl Thorburn, Bogart Laura M, Delahanty Douglas L
Department of Public Health, Oregon State University, Corvallis, Oregon 97331-6406, USA.
AIDS Patient Care STDS. 2004 Jan;18(1):19-26. doi: 10.1089/108729104322740884.
Negative interactions with health care providers can have important implications for the health and health care of HIV-positive individuals. The purpose of this study was to examine perceptions of race-based and socioeconomic status (SES)-based discrimination during interactions with HIV treatment providers. We recruited 110 individuals (17% female, 51% white) living with HIV from an AIDS service organization in a midwestern city. Results indicated that the majority of participants had perceived discrimination in their interactions with providers when getting treatment for HIV. More specifically, 71% reported having experienced discrimination when receiving treatment for HIV based on their race or color, and 66% reported discrimination attributed to their socioeconomic status, position, or social class. However, participants indicated that they experienced discrimination infrequently. No significant racial/ethnic differences in reports of discrimination were observed. In addition, greater race-based and SES-based discrimination were each associated with greater levels of depression and posttraumatic stress symptoms, greater severity of AIDS-related symptoms, lower perceived general health, and less health care satisfaction. Greater SES-based discrimination was also related to lower adherence to antiretroviral medications. Our findings suggest that experiences with discrimination when getting treatment have important implications for the health and health care of HIV-positive individuals. It is important to note, however, that discrimination based on HIV status or sexual orientation was not assessed and may have affected the results. Studies that explore perceptions of discrimination based on other factors among HIV-positive individuals may improve understanding of the nature, extent, and consequences of discrimination in patient-provider interactions.
与医疗服务提供者的负面互动可能会对艾滋病毒呈阳性个体的健康及医疗保健产生重要影响。本研究的目的是调查艾滋病毒治疗提供者在互动过程中基于种族和社会经济地位(SES)的歧视认知情况。我们从一个中西部城市的艾滋病服务组织招募了110名艾滋病毒感染者(17%为女性,51%为白人)。结果表明,大多数参与者在接受艾滋病毒治疗时,都感觉在与提供者的互动中受到了歧视。更具体地说,71%的人报告在接受艾滋病毒治疗时因种族或肤色而受到歧视,66%的人报告因社会经济地位、职位或社会阶层而受到歧视。然而,参与者表示他们很少受到歧视。在歧视报告中未观察到显著的种族/族裔差异。此外,基于种族和SES的歧视程度越高,分别与更高水平的抑郁和创伤后应激症状、更严重的艾滋病相关症状、更低的总体健康感知以及更低的医疗保健满意度相关。基于SES的歧视程度越高,对抗逆转录病毒药物的依从性也越低。我们的研究结果表明,治疗过程中的歧视经历对艾滋病毒呈阳性个体的健康及医疗保健具有重要影响。然而,需要注意的是,本研究未评估基于艾滋病毒感染状况或性取向的歧视,其可能影响了研究结果。探索艾滋病毒呈阳性个体基于其他因素的歧视认知的研究,可能会增进对医患互动中歧视的性质、程度和后果的理解。