Bias in the Clinic

Posted in: News 2005-Older

One in four people receiving care in the U.S. for an HIV infection report experiencing discrimination from a health care provider, according to a new study. And more than half of them cite their physicians as the individual who discriminated against them.

The study, published in the current issue of the Journal of General Internal Medicine, also noted a strong association between reported discrimination and indicators of poor quality care.

The study’s authors, led by University of California, Los Angeles professor and RAND Corp. researcher Dr. Mark Schuster, reviewed data from a 1996-1997 survey of 2,466 adults infected with HIV, which was part of a massive healthcare study known as the HIV Cost and Utilization Study. A third of the survey participants were Black and 15% were Latino. The respondents were overwhelmingly male, at 77%.

The survey asked participants if they had experienced any one of four types of discrimination while getting care: if a provider had been “uncomfortable with you,” “treated you as inferior,” “preferred to avoid you,” or refused service.

Twenty-six percent of those interviewed answered yes to at least one of these questions, with the highest number, 20%, saying their healthcare provider had been uncomfortable with them. Eight percent said they had been refused service.

African Americans were the least likely group to report discrimination. While 32% of whites and 21% of Latinos said they had been treated differently because of their HIV status, only 17% of Blacks said the same. Schuster’s team, however, suggested the racial differences may say more about expectations than actual treatment.

“African-Americans and Latinos may typically experience worse care and thus be unaware that better care exists,” the researchers wrote. Meanwhile, they posited, white male HIV patients may be experiencing the “black sheep” effect, where “clinicians might feel more hostility to people who are generally similar to themselves except for characteristics that they view negatively, such as being gay or having HIV.”

But Schuster’s team also stressed that the findings are narrow: They show only that lots of people getting care for HIV feel like they are being treated differently. The study did not measure actual behavior of providers. The researchers urged clinicians to be mindful of conditions that may foster the perceived discrimination, “whether real or misunderstood.”

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