Influencing African Americans’ Decision to Provide HIV Care: Greater Focus on Medically Underserved Communities and Health Equity Hujdich, B., Johnson, A., Orose, J., Salazar, J., & Welch, N.
HealthHIV, Washington, D.C., USA Introduction: African Americans Disproportionately Affected by HIV/AIDS
Materials and Methods: Nationwide Survey with over 1,800 Respondents
According to the Centers for Disease Control and Prevention (CDC), African Americans are disproportionately affected by HIV/AIDS and account for more HIV/AIDS cases than any other racial/ ethnic group in the U.S (Figure 1). Additionally, it is estimated that 3.8 million African Americans currently uninsured will gain coverage as a result of Medicaid expansion and the creation of Affordable Insurance Exchanges1, some of whom will be HIV positive.
HealthHIV’s 2nd Annual State of HIV in Primary Care survey was implemented to identify trends in the provision of HIV care among primary care providers (PCPs) and credentialed HIV Specialists. The national survey was conducted online with respondents recruited through targeted invitations between July and October 2011. HealthHIV and Medscape fielded the 45-question instrument in Survey Monkey™. The respondents included 627 prescribing clinicians, 82 of whom identified as African American.
The HIV workforce is aging2, including the 77.9% of African American providers 35 years of age and older. Identifying motivational factors that drive the HIV workforce is critical to building the next generation of providers, and ensuring that culturally appropriate HIV services are provided to diverse, high-risk populations.
Figure 1. African Americans are more impacted by HIV in the United States than any other racial/ ethnic group. From Prejean J, Song R, Hernandez A, Ziebell R, et al. (2011) Estimated HIV Incidence in the United States, 2006–2009. PLoS ONE 6(8): e17502. doi:10.1371/journal.pone.0017502.
Figure 2. The 2nd Annual State of HIV in Primary Care surveyed 627 prescribing clinicians. The map above shows the geographic distribution of African American clinicians as compared to clinicians of other races.
Results: Interest in Underserved Communities is Main Motivating Factor for African American Providers to Deliver HIV Care Figure 5. African American respondents indicated that they perceive stigma as a barrier to routine HIV testing more often than providers of other races.
Figure 3. Factors influencing providers’ decisions to focus on HIV care. African American Providers Drivers to Focus on HIV Care
90%
African American Providers
85%
80%
76%
80%
African American Providers
Caucasian Providers
71% 70%
African American Providers Cite Stigma as a Barrier to HIV Testing
Non-African American Providers 63%
63% 60%
60% 50%
50% 40%
48%
49%
49%
50% 36%
34%
40%
30% 20% 20%
10% 0% Interest in medically underserved communities
Health equity, health High HIV prevalence Impact of HIV training disparities and HIV primary care or education demand in my area
I am a part of a community highly impacted by HIV
African American respondents cited “interest in medically underserved communities” (85%), “concern about health equity and disparities” (76%) and “significant need in the area” (71%) as their biggest factors influencing their decision to focus on HIV.
0%
1
Figure 6. African American respondents indicated that they are more likely to offer HIV testing than other providers.
Figure 4. African American Respondents indicated many social and behavioral issues as barriers to care.
African American Providers Are More Likely to Offer HIV Testing 100%
African American Providers
83% 80% 71%
Non-African American Providers
60%
40% 29% 17%
20%
0%
Yes
No
Conclusions: Health Disparities a Key Motivating Factor in Influencing African American Providers’ Decision to Focus on HIV Care
Implications: Understanding Motivational Factors of African American Providers is Integral to Diversifying and Expanding HIV Workforce
Survey results demonstrated that African American providers are driven to respond to the needs of their communities. For instance, African American providers stated that they were influenced to deliver HIV care by social and community factors (i.e. underserved communities, health disparities). Results show that African American providers are more aware of societal barriers to HIV care, and also provide more HIV testing.
As the number of HIV care providers decreases, there is a great need to recruit a new generation to address the ever more complex treatment of HIV. By targeting providers based on motivating factors, it is possible to recruit a motivated and diverse workforce that is more representative of the populations they serve.
Acknowledgements: HealthHIV, Medscape, Versta Research
Literature Cited 1. Robinson W, & Finegold K. The Affordable Care Act and African Americans. http://aspe.hhs.gov/health/reports/2012/ACA&African-Americans/rb.shtml. Updated April 2012. Accessed July 7, 2012. 2. American Association of Medical Colleges. Diversity in the Physician Workforce: Facts & Figures 2010. Accessed July 7, 2012
Presented at AIDS2012 – Washington, DC, USA