Brief report: HIV-related healthcare stigma/discrimination and unmet needs among persons living with HIV in England and Wales

John Mark Wiginton; Jessica L Maksut; Sarah M Murray; Jura L Augustinavicius; Meaghan Kall; Valerie Delpech; Stefan D Baral

doi:10.1016/j.pmedr.2021.101580

Brief report: HIV-related healthcare stigma/discrimination and unmet needs among persons living with HIV in England and Wales

Prev Med Rep. 2021 Oct 3:24:101580. doi: 10.1016/j.pmedr.2021.101580. eCollection 2021 Dec.

Authors

John Mark Wiginton¹, Jessica L Maksut², Sarah M Murray³, Jura L Augustinavicius³, Meaghan Kall⁴, Valerie Delpech⁴, Stefan D Baral²

Affiliations

¹ Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
² Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ HIV and STI Department, National Infection Service, Public Health England, London, UK.

Abstract

We characterized the prevalence of, and estimated associations between, (1) HIV-related healthcare stigma/discrimination and (2) unmet social, mental, and chronic condition healthcare needs among persons living with HIV (PLHIV) in England and Wales. We used data from Positive Voices 2017, a national, cross-sectional probability survey of PLHIV in England and Wales, in which N = 3,475 PLHIV provided complete data on demographic characteristics (control variables; age, ethnicity, gender, sexual identity), HIV-related healthcare stigma/discrimination (exposures; treated differently from other patients, care was refused/delayed, worried about being treated differently, avoided seeking needed care, all due to HIV status), and unmet needs (outcomes; unmet peer support, psychological care, management of chronic health conditions, and isolation help needs). Modified Poisson regression models with log links and robust variance estimators were used to produce prevalence ratios and 95% confidence intervals for unadjusted and adjusted associations between demographic characteristics, HIV-related healthcare stigma/discrimination (individual items and total scale score), and unmet needs variables. Two in five participants (40%) endorsed at least one HIV-related healthcare stigma/discrimination item; and 474 (14%), 428 (12%), 459 (13%), and 501 (14%) reported an unmet peer support, psychological care, chronic health condition management, and isolation help need, respectively. Each HIV-related healthcare stigma/discrimination item and the summed scale score were significantly, positively associated with all four unmet needs variables in unadjusted and adjusted models. Trainings for all healthcare workers in HIV-competent, non-stigmatizing care, as well as the development of engagement and delivery approaches for psychosocial care for PLHIV, are needed.

Keywords: England; HIV-related healthcare stigma/ discrimination; Healthcare; Persons living with HIV; Unmet needs; Wales.