People Facing HIV Stigma Are Less Likely To Make Their Next Care Visit

Although HIV stigma is widely acknowledged as a barrier to engagement with care, there has been a lack of large-scale, nationally representative research evaluating the on retention in US HIV care settings.

At the 2020 Conference on Retroviruses and Opportunistic Infections (CROI 2020), investigators shared findings in a virtual poster presentation that show HIV stigma predicts retention in care among patients in the United States.

The study team used medical record and survey data gathered in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. The CNICS database includes patients in primary care at 7 different academic clinics in the United States.

Stigma was quantified using surveys with a 4-item assessment of internalized negative beliefs about people living with HIV. Patients evaluated statements from 1-5 (strongly disagree to strongly agree). Surveys were administered every 4 to 6 months at primary care visits.

The study team used multivariable logistic regression models to assess associations between stigma and 2 retention in care outcomes. The outcomes pertained to whether the patient kept their next primary care appointment and whether they kept all scheduled primary care appointments in the year after the stigma assessment.

Controlling for gender, race, sexual orientation, age, and location, the investigators found an association between mean stigma and decreased retention of care.

Between April 2016 and October 2018, 5825 patients completed a stigma assessment. Of these patients, 80% were male and 32% identified as heterosexual. Additionally, 39% of patients were black and 15% were Hispanic. The median age was 49 years.

The mean stigma was 1.9 (standard deviation 1.08). For each unit increase in mean stigma, there was an associated decrease in odds of keeping the next primary care appointment and of keeping all primary care appointments within the year.

“In one of the first multi-site, clinic-based studies of stigma in the US, internalized HIV stigma had a modest statistically significant independent effect on the likelihood of subsequent appointment attendance. This is the first study to demonstrate prospectively the effect of stigma on retention in care, thereby providing support for the need to address HIV stigma in efforts to optimize retention in HIV care and virologic control,” the investigators wrote in their abstract.

The poster, HIV Stigma Predicts Retention In Care Among US Patients In Care, was virtually presented in a poster session at CROI 2020 on Tuesday, March 10, 2020.