The impact of stigma on US health care provider perceptions, treatment, and care of people who may be exposed to or living with HIV

Abstract

This study explored the impact of HIV-related stigma on U.S.-based health care providers' (HCPs) confidence and comfort discussing HIV-related topics and providing HIV-related care. It also explored what factors might be associated with such stigma. We developed multivariable models to investigate if stigmatizing beliefs about pre-exposure prophylaxis (PrEP) users, stigmatizing beliefs about people with HIV, and fear of infection (instrumental stigma) are associated with HCPs' demographic characteristics and professional experience. We analyzed how these stigmas are associated with HCP behaviors critical to the HIV prevention and care continuum, such as comfort communicating with patients about prevention and comfort providing care. Across all stigma measures, we found certain types of stigma were associated with identifying as male, identifying as Asian (compared with white), practicing in the South, and having lower knowledge of HIV practices. Many HCP experience-related variables, such as prescribing PrEP to patients, providing primary care for people with HIV, or number of HIV tests ordered, were not associated with HIV-related stigma. More stigmatizing beliefs about people who use PrEP and more instrumental stigma were associated with less comfort communicating with patients about prevention and testing, prescribing PrEP, and providing HIV treatment. The results contribute to understanding the characteristics of HCPs who might hold stigmatizing beliefs and how these beliefs impact their comfort with discussing and providing HIV-related services. Future work includes opportunities for refining an overarching HIV-related stigma framework to inform stigma reduction intervention message development.