Stigma Remains a Significant Barrier to Routine HIV Testing by African-American Physicians, Survey Finds
Physicians Report Only One-Third of Patients Routinely Tested in the Past Year Despite Growing Prevalence of HIV Diagnoses Among African Americans
Titusville, NJ -- Social stigma is the largest barrier to routine HIV testing by African-American frontline care physicians, according to a survey commissioned by Janssen Therapeutics, Division of Janssen Products, LP, in collaboration with the National Medical Association (NMA).(1) Despite the belief by most physicians surveyed (93 percent) that HIV is either very serious or a crisis in the African-American community, findings suggested that only one-third of all patients in these physicians’ practices were tested within the past year.
In the United States, the number of people living with HIV infection is higher than ever before, and African Americans account for almost half of all new HIV infections. African Americans also comprise a higher proportion of new cases compared with members of other races and ethnicities.(2) Since September 2006, the Centers for Disease Control and Prevention (CDC) has recommended that diagnostic HIV testing and optional HIV screening be a part of routine clinical care in all healthcare settings.(3)
“The survey findings tell us that despite HIV education efforts, the stigma surrounding the disease is still very strong and is a significant barrier to routine testing among African-American doctors,” said Wilbert C. Jordan, MD, MPH, Medical Director of the OASIS Clinic of King/Drew Medical Center and member of the NMA. “With African Americans more likely to contract HIV than any other ethnic group, this is particularly concerning as the study uncovered that most patients decide to get tested based on their physician’s recommendation. It’s crucial that we educate doctors and patients by providing the resources they need to make HIV testing a routine practice.”
Social Stigma is the Main Barrier to Recommending Testing
The survey found that three of the top five barriers to routine testing cited by African-American physicians relate to social stigma. Specifically, physicians are concerned that patients may perceive the recommendation to test as accusatory or judgmental (57 percent); would not want to be identified as HIV positive and would worry about people finding out (48 percent); and would be offended due to the stigma associated with HIV (43 percent). Competing priorities and lack of time with patients were each cited by 45 percent of physicians as reasons why they do not routinely test.
Risky Behaviors Tend to Prompt Testing Recommendation
Physicians surveyed estimate that 70 percent of patients tested in the past year did so because of the physician’s recommendation. Yet, the physicians surveyed tend to take a risk-based testing approach, recommending HIV testing for individuals based on perceived high-risk behaviors, including multiple sex partners (89 percent), injection drug use (85 percent), suspected commercial sex work (77 percent), homosexuality (77 percent) and previous incarceration (70 percent). For the majority (86 percent), it is easiest to raise HIV testing with patients who are perceived to be at risk.
Variance in Testing Based on Physician Demographics
Thirty-six percent of all physicians surveyed were categorized as “high testers,” routinely testing more than 25 percent of their patients for HIV. These physicians tend to test routinely for all sexually active patients, be younger (under 40), female, and are more likely to be specializing in obstetrics and gynecology.
Physician Recommendations to Drive More Routine HIV Testing
The physicians surveyed proposed solutions to help increase routine testing in the primary care setting. These include patient-focused communication stressing the importance of getting tested, such as in-office posters and brochures (52 percent) and increased media attention (51 percent). Additional suggested resources included more training on testing (44 percent) and the availability of accurate in-office prepackaged HIV tests (42 percent). Despite the 2006 CDC recommendations for HIV testing, many physicians said that having a government mandate requiring routine HIV testing would help them to test more (43 percent).
“Early detection of HIV is critical, and that’s why it’s important to raise awareness of the need for annual HIV testing as part of routine blood work,” said Cedric Bright, MD, President of the NMA. “The NMA supports and encourages its physicians in the primary care arena to adopt annual HIV testing of their patients. Together we can help make a difference in the fight against HIV.”
A total of 502 surveys were completed by African-American physicians online at the NMA Conference or via email; 65 percent of respondents were NMA members. The survey consisted of 11 screening questions and 38 survey questions. The online panel surveys were collected in two waves: one in late July and early August of 2010, the second from mid-October through early November. The NMA Conference intercept surveys were collected at the conference in early August of 2010, while the post-conference email survey data were collected from mid-September to mid-October.
Physicians had to meet the following eligibility criteria:
-African-American practicing physician working predominantly with adults
-Primary care physicians (general physician, family practitioner, internal medicine) or other physicians who are on the frontline of general care, such as OB/GYN
-At least 20 percent of his or her patients must be African American
-Must have been in practice for at least one year
The survey was funded by Janssen Therapeutics, Division of Janssen Products, LP, developed in collaboration with the NMA and conducted by Cheskin Added Value.
About Janssen Therapeutics
As a member of the Janssen Pharmaceutical Companies of Johnson & Johnson, Janssen Therapeutics, Division of Janssen Products, LP, headquartered in Titusville, New Jersey, is dedicated to delivering innovative virology therapeutics that help healthcare professionals address serious unmet needs in people living with HIV and other infectious diseases.
About the National Medical Association
Founded in 1895, the National Medical Association is the nation’s oldest and largest medical association representing the interests of more than 50,000 African-American physicians and their patients. The National Medical Association advocates for policies that assure equitable and quality health care for all people. Visit the National Medical Association at www.nmanet.org.
(1) Jordan W, Stone V, DeLaitsch L, et al. “HIV Testing Among African-American Frontline Providers in the US.” National Medical Association Twelfth National Colloquium on African American Health. Washington, DC March 13, 2011.
(2) Centers for Disease Control and Prevention. (September 9, 2010). HIV among African Americans. http://www.cdc.gov/hiv/topics/aa/index.htm. Accessed June 2011.
(3) Centers for Disease Control and Prevention. (September 26, 2006). Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm. Accessed June 2011.
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