Increased rates of stigmatizing events in healthcare contexts reported by HIV-positive men who have sex with men (MSM): Implications for Treatment as Prevention (TasP)

HIV secondary prevention efforts stress quality relationships between HIV-positive patients and their healthcare providers for optimal clinical outcomes; however, these relationships are undermined when patients perceive the presence of dislike or discrimination directed towards them. As Treatment as Prevention (TasP) becomes vital to curtail the spread of the disease, positive interactions with the healthcare system are paramount to ensure adherence, especially by MSM.

About 1500 MSM completed surveys regarding their healthcare experiences. In addition to HIV status, participants indicated if they had experienced one or more of ten types of stigmatizing events in healthcare contexts following disclosure of their sexual orientations, along with other patient-provider attitudes. 

Of those surveyed, 282 (19.2%) identified as HIV-positive and 550 (37.5%) reported experiencing one or more types of stigmatizing encounters in healthcare contexts following disclosure of their sexual orientations. More than 49% of the HIV-positive MSM reported these stigmatizing events in healthcare contexts, which made them 82.7% more likely to report such experiences than their HIV-negative peers (p<.01; 95% CI, 1.4-2.4). Physician’s contextual knowledge, interpersonal treatment, communication, and trust all predicted a reduction in problematic encounters for HIV-positive men.

Observation of overt or even subtle signals of dislike from care providers can affect patients’ perceptions of the quality of care they receive, as well as their trust in and likelihood of returning to suspect care providers. For HIV-positive MSM, this may then translate into diminished use or even avoidance of healthcare, which would undermine health maintenance and secondary HIV prevention efforts such as TasP.