Sohler Nancy, Li Xuan, Cunningham Chinazo
Sophie Davis School of Biomedical Education, City University of New York, 138th St. and Covent Ave., City College Campus, New York, NY 10031, USA.
Public Health Rep. 2007 May-Jun;122(3):347-55. doi: 10.1177/003335490712200308.
Studies continue to document that people with human immunodeficiency virus (HIV) experience discrimination in their interactions with the health-care system, which can have negative implications for maintaining continuity in care and outcomes. We explored the patient characteristics associated with perceived discrimination and whether these experiences are associated with health-care system quality ratings in a survey of severely disadvantaged people with HIV who are at great risk of inconsistent access to appropriate health care.
Five hundred and twenty-three participants were recruited from temporary housing facilities for people with HIV in the New York City area and administered a survey using audio computer-assisted self-interviewing technology.
Of the 207 participants (39.6%) who reported experiencing discrimination in the health-care system, the most common attributions were HIV infection (n = 122, 59.8%), drug use (n = 100, 49.8%), homelessness (n = 71, 34.6%), and race/ethnicity (n = 69, 35.2%). Length of time HIV infected, use of non-prescription opioids, white race, higher education, female gender, younger age, and poorer self-reported health status were all significantly associated with greater odds of perceived discrimination. After adjusting for participant characteristics, perceived discrimination was significantly associated with poorer participant ratings of quality of health care.
Members of this vulnerable population commonly report experiences of discrimination from within the health-care system and these experiences are associated with poor health-care ratings. These findings support the need for closer examination of the adequacy of cultural competency training within the HIV health-care delivery system to improve access to appropriate care for disadvantaged people.
研究不断证明，感染人类免疫缺陷病毒（HIV）的人在与医疗保健系统互动时会遭遇歧视，这可能对维持持续治疗及治疗效果产生负面影响。在一项针对严重弱势且极有可能无法持续获得适当医疗保健的HIV感染者的调查中，我们探究了与感知到的歧视相关的患者特征，以及这些经历是否与医疗保健系统质量评级有关。
从纽约市地区为HIV感染者提供的临时住房设施中招募了523名参与者，并使用音频计算机辅助自我访谈技术对他们进行了一项调查。
在报告在医疗保健系统中遭遇歧视的207名参与者（39.6%）中，最常见的归因因素是HIV感染（n = 122，59.8%）、药物使用（n = 100，49.8%）、无家可归（n = 71，34.6%）以及种族/族裔（n = 69，35.2%）。感染HIV的时长、使用非处方阿片类药物、白人种族、高等教育程度、女性性别、较年轻的年龄以及自我报告的较差健康状况均与更高的感知歧视几率显著相关。在对参与者特征进行调整后，感知到的歧视与参与者对医疗保健质量的较低评分显著相关。
这一弱势群体的成员普遍报告在医疗保健系统中遭遇歧视的经历，且这些经历与较差的医疗保健评级相关。这些发现支持有必要更仔细地审视HIV医疗保健提供系统内文化能力培训的充分性，以改善弱势群体获得适当医疗服务的机会。
