Abstract

THPE467 - Poster Exhibition

Stigma and HIV testing: measuring change among Pacific AIDS Education and Training Center's (PAETC) low prevalence providers

N. Warren¹, M. Bernstein¹, M. Reyes<sup>2

1</sup>Pacific AIDS Education and Training Centers, San Francisco, United States, ²Pacific AIDS Education and Training Centers, UCSF-FCM, San Francisco, United States

Background: Low-resource, low HIV prevalence US communities continue to have low rates of HIV screening, despite state and federal promotion of HIV testing. Our two-part formative research assessed the level to which HIV stigma posed a barrier to clinicians´ HIV testing their patients in these settings.
Methods: PAETC conducted 4 focus groups from 2009 to 2010 in California's Central Valley, the California/Arizona border with Mexico, and the U.S. Pacific Jurisdictions, interviewing 25 clinician participants who worked predominantly in community clinics, hospitals, and health departments.. A search for validated quantitative surveys to further explore HIV-related stigma among the clinicians PAETC trains, uncovered stigma surveys that were mostly outdated or focused on clinicians in Africa and Asia with very few questions appropriate for the current US context. Using the results of these focus groups, PAETC developed an instrument that included questions relevant to the current US practice context. These questions were created from the findings of our focus groups.
Results: Qualitative focus groups results identified clinicians´ stigmatized views of HIV as a major barrier to HIV testing. Themes that emerged include stigma based on socio-demographics including sexual orientation, gender identity and substance use. Participants also reported a “new” stigma: a perception that HIV testing will overly tax clinician time and resources, impacting negatively on revenue generating activities. Participants also associated discussions of sex or drugs with their patients as overly time intensive activities. For many, these discussions were to be avoided because of their stigmatized views of people who engaged in sexual practices or substance use outside a very narrowly defined norm.
Conclusions: Initial qualitative findings indicate that US clinician-level HIV stigma appears to pose a barrier to HIV testing in low-resource, low prevalence US communities. These findings indicate that most instruments developed to measure stigma are not adequate for the current US context.