Quantifying HIV Stigma Among Hispanic and Latino Populations

Hispanic or Latino (Hispanic) patients with HIV experience more health care disparities and discrimination events compared to other racial groups, according to the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

Investigators from the CDC used data from the Medical Monitoring Project between 2018 and 2020 in order to understand and eliminate the barriers to HIV care and treatment. The data included self-reported stigma and health care discrimination reports from 2690 adult Hispanic participants.

A previous report, the study authors noted, found that Hispanic patients who received HIV care, were retained in care, and were virally suppressed at levels lower than their non-Hispanic counterparts.

The participants were made up of a group that was 81 percent male, the study authors noted, including 66 percent who identified as white, 13 percent who identified as Black, and 4 percent who identified as American Indian or Alaska Native. The study authors also were able to trace Hispanic heritage, with 36 percent reporting Mexican, Mexican American or Chicano heritage, 34 percent identified their heritage as Puerto Rican; additionally, about two-thirds (62 percent) were born outside the continental US, 22 percent were born in Puerto Rico, and 19 percent in Mexico. The study authors added that 42 percent of participants reported limited English proficiency.

The highest reported median HIV stigma scores on a scale of zero to 100 was 31.7, with women and American Indian or Alaska Native patients reporting the highest scores among Hispanic persons with HIV, the study authors reported, at 35.6 and 38.9, respectively. The study authors also found that HIV stigma was primarily attributed to disclosure concerns (between 48 and 78 percent of participants), which include fearing others will reveal someone’s HIV status and being careful about who knows someone’s HIV status. Between 20 and 28 percent of participants agreed with the items about perceived public attitudes – including feelings of disgust and rejection related to a positive HIV status – the study authors determined.

Almost a quarter of Hispanic persons with HIV (23 percent) reported health care discrimination, the study authors observed. It was more frequently experienced by Hispanic men (23 percent) compared to Hispanic women (18 percent), they found, as well as by Black or African American Hispanic persons (28 percent) compared to White Hispanic persons (21 percent).

“Understanding disparities in experiences of stigma and discrimination is important when designing culturally appropriate interventions to reduce stigma and discrimination,” the study authors wrote.

Examining health care discrimination events, 22.6 percent of Hispanic persons with HIV reported experiencing any discrimination in the prior 12 months, the study authors found: 8 percent reported 1 event, 4 percent reported 2 events, and 11 percent reported 3 or more events. These events were categorized by the following types of experiences, as explained by the study authors:

• 62 percent felt that a doctor or nurse was not listening to what they were saying
• 48 percent felt they were treated with less respect than others
• 48 percent perceived they were treated with less courtesy than others

The participants were also asked to attribute their discrimination to certain qualities:

• 30 percent attributed health care discrimination to their HIV infection
• 23 percent to their sexual orientation or sexual practices
• 20 percent to their race or ethnicity

Hispanic men were more likely than Hispanic women to experience health care discrimination, as were multiracial Hispanic patients compared to white Hispanic counterparts, the study authors found. They also noted that those born inside compared to outside the U.S. experienced more discrimination, specifically those born in Mexico, Central America, and South America compared to a U.S.-born person.

“Data disaggregation among Hispanic persons with HIV revealed disparities in stigma and discrimination experiences,” the study authors concluded. “Designing multilevel, culturally, and linguistically appropriate approaches that address stigma and discrimination, particularly among priority populations such as Hispanic persons with HIV, is key to improving care and treatment outcomes and ending the HIV epidemic.”