Baugher Amy R, Beer Linda, Fagan Jennifer L, Mattson Christine L, Shouse R Luke
a Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , USA.
AIDS Care. 2019 Sep;31(9):1077-1082. doi: 10.1080/09540121.2018.1545988. Epub 2018 Nov 15.
The prevalence of discrimination in healthcare settings among HIV patients in the United States is unknown. The Medical Monitoring Project (MMP) is a complex sample survey of adults receiving HIV medical care in the United States. We analyzed nationally representative MMP data collected 2011-2015. We assessed the prevalence of self-reported healthcare discrimination, perceived reasons for discrimination, and factors associated with discrimination among persons with HIV diagnoses ≤5 years before interview ( = 3,770). Overall, 14.1% of patients living with HIV (PLWH) experienced discrimination, of whom 82.2% attributed the discrimination to HIV. PLWH reporting poverty, homelessness, or attending a non-Ryan White HIV/AIDS Program (RWHAP) facility were more likely to report discrimination compared with other groups. Of patients attending non-RWHAP facilities, discrimination was higher among those in poverty (27.5%) vs. not in poverty (15.1%). Discrimination was associated with homelessness regardless of facility type, and was highest among homeless persons attending non-RWHAP facilities. Healthcare discrimination was commonly reported among PLWH, and was most often attributed to HIV status. Discrimination was higher among those reporting poverty or homelessness, particularly those attending non-RWHAP facilities. Incorporating practices, such as anti-discrimination training, in facilities may reduce healthcare discrimination.
美国医疗环境中针对艾滋病病毒(HIV)患者的歧视现象普遍程度尚不清楚。医疗监测项目(MMP)是一项针对美国接受HIV医疗护理的成年人的复杂抽样调查。我们分析了2011年至2015年收集的具有全国代表性的MMP数据。我们评估了自我报告的医疗歧视的普遍程度、感知到的歧视原因以及与在访谈前确诊HIV时间≤5年的人群(n = 3770)中的歧视相关的因素。总体而言,14.1%的HIV感染者(PLWH)经历过歧视,其中82.2%将歧视归因于HIV。与其他群体相比,报告有贫困、无家可归或在非瑞安·怀特HIV/艾滋病项目(RWHAP)机构接受治疗的PLWH更有可能报告遭受歧视。在非RWHAP机构接受治疗的患者中,贫困患者的歧视发生率(27.5%)高于非贫困患者(15.1%)。无论机构类型如何,歧视都与无家可归有关,在非RWHAP机构接受治疗的无家可归者中歧视最为严重。PLWH中普遍报告存在医疗歧视,且最常归因于HIV感染状况。报告有贫困或无家可归的人群中歧视更为严重,尤其是那些在非RWHAP机构接受治疗的人。在机构中纳入反歧视培训等做法可能会减少医疗歧视。