A Multifaceted Strategy to Reduce HIV-Related Stigma and Disparities BY MILENA MURRAY, PHARMD, MSC, BCIDP, AAHIVP, FCCP
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ocial determinants of health are defined as the conditions in which people are born, grow, work, live, and age, as well as the wider set of forces and systems shaping the conditions of daily life.1 The 40-year HIV epidemic, in addition to the more recent COVID19 pandemic, has produced data that these factors have a role in the transmission, morbidity, and mortality of infectious diseases.1 New data emerged regarding the effect of social determinants on patient outcomes and several disease states. However, disparities have long been known to harm people with HIV. HIV-related stigma also is associated with several adverse outcomes.2 HIV transmission is related to local HIV prevalence, individual behaviors, biological factors, and social conditions.3 Disparities are found in HIV transmission, access to treatment, and disease course. It is imperative to
consider that disease is influenced by community, societal, and environmental factors.1 As part of HIV treatment, adherence to treatment and the ability to achieve undetectable HIV RNA is affected by HIV-related stigma.2 Many advances have been made in HIV treatment and prevention; however, not all people with HIV have access to the same treatment and some individuals cannot adhere to treatment for various reasons. Social support, specifically tangible support networks, is critical for linkage to care and antiretroviral therapy (ART) adherence.4 Limited health literacy also affects the relationship between the patient’s race and ART adherence. Health literacy is a modifiable factor; patient materials should be written at an appropriate reading level.5 This particular disparity may be reduced by improving patient
education materials and using more suitable communication modes. Positive reinforcement and an expression of thanks for keeping appointments may foster adherence success.6 Stigma is additionally related to the fear of discrimination and rejection by healthcare service providers. This discrimination may lead to medical mistrust, resulting in a vicious cycle of disparity.4 People who are transgender experience health disparities and discrimination across the HIV continuum of care. A case-control study compared transgender women with HIV with cisgender women and cisgender men with HIV.4 Measures of the HIV treatment cascade and correlates of HIVrelated health status (eg, depression, stress, drug use, medical mistrust, emotional and tangible social support) were assessed. Transgender women were significantly less likely to receive
INFECTIOUS DISEASE SPECIAL EDITION • SPRING 2022
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