Stigma Prevents HIV Testing By Black MDs

TITUSVILLE, N.J.,  -- Social stigma is the largest barrier to routine HIV testing by African-American frontline care physicians, according to a new National Medical Association survey.

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.

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.

"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.

Dr. Jordan continues, "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."

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.

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.

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.

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."