Social Vulnerabilities and Reported Discrimination in Health Care Among HIV-Positive Medical Case Management Clients in New York City

Abstract

We aimed to investigate the extent to which social vulnerabilities correlated with lifetime experience of discrimination in health care among people with HIV receiving services to improve treatment adherence and viral suppression. Individuals (N = 687) enrolled in a Ryan White Part A medical case management program were surveyed about discrimination experienced in health care settings, reasons for any discrimination faced, and self-reported health. We merged data from the survey with data from the New York City HIV Surveillance Registry and a programmatic database to obtain client sociodemographic and clinical characteristics and reported history of social vulnerabilities. Thirty-nine percent of participants reported lifetime experience of discrimination in health care settings; individuals with a history of at least 3 social vulnerabilities (mental health diagnosis, incarceration, substance use, and/or housing instability) had more than twice the odds of reporting discrimination than individuals who did not report any of these social vulnerabilities (adjusted odds ratio = 2.33 [95% confidence interval = 1.43, 3.83]). Among individuals who reported discrimination in health care, those who cited HIV status or substance use as reasons for discrimination were significantly more likely to report a higher number of social vulnerabilities (p =.04 and p =.009, respectively), with discrimination because of HIV status most strongly associated with a mental health diagnosis. These findings underscore the importance of acknowledging life experience and psychosocial barriers in provider interactions with people with HIV. They also highlight a need for monitoring provider attitudes and behaviors regarding intersectional stigmas related not only to factors such as race and sexual orientation but also to social vulnerabilities.