Background: Stigma and discrimination remain important barriers to HIV prevention and care. We examine the association between experiences of HIV discrimination in healthcare with worry about and avoidance of care.
Methods: STIGMASurveyUK 2015 is a community led project. Participants reported their experiences at a range of health care settings in the previous 12 months in an online anonymous survey. A ''discrimination'' composite was based on the sum of scores of five questions regarding: being treated differently to other patients, refused treatment, given the last appointment of the day not by choice, and experiencing negative comments about people living with HIV or excess attention to barrier protection by healthcare workers. Descriptive, univariate and multivariate analyses were performed.
Results: 1528 participants (97%) completed the healthcare section. Mean age was 44 years (range 18­ - 83 years). 1152 (76%) were male (948 [82%] identified as men who have sex with men) and 344 (23%) female (322 [93%] identified as heterosexual). 555 (36%) identified as Black, Asian or minority ethnic.
41% of participants (628) reported experiencing discriminatory treatment in a healthcare setting; 46% (147) of Black African or Caribbean participants reported discrimination compared to 41% (385/699) of white British (p< 0.001); and 18/32 (56%) trans compared to 41% of other participants (p=0.034).
Overall 60% (910) reported worrying about being treated differently to other patients and 29% (439) reported avoiding healthcare when required.
Of the 628 participants who experienced discriminatory treatment, 89% and 54% (n=628) reported worrying about being treated differently and avoiding care respectively. These figures were significantly higher compared to the 766 participants who reported no discrimination (27% and 10% respectively; p< 0.001 for both).
Experience of discrimination in healthcare was strongly associated with both worry about discriminatory treatment (aOR 14.25, CI10.10, 20.09) and avoidance of care when required (aOR 8.70, CI6.27, 12.07) after adjustment for demographics, diagnosed depression, time of diagnosis, disability, injecting drug use, self-image and resilience.
Conclusions: Experiences of discriminatory treatment in healthcare settings are strongly and independently associated with worry about care and avoiding seeking care when required. Sensitivity training targeted at healthcare workers to reduce discriminatory treatment of HIV-positive patients is required.