Examining barriers to care: Provider and client perspectives on the stigmatization of HIV-positive Asian Americans with and without viral hepatitis co-infection

Abstract

Between 1999 and 2003, Asian Americans and Pacific Islanders (APIs) in the US experienced more rapid growth in the number of AIDS cases than any other racial or ethnic group. In addition, the prevalence of HBV and HIV co-infection is estimated to be significantly higher among APIs in the US than in other racial/ethnic groups. High rates of HIV and hepatitis B or C (HBV and/or HCV) co-infection, in concert with language and cultural barriers, create significant challenges to effective coordination of treatment. The purpose of this study is to identify barriers to care and treatment in APIs with HIV with and without hepatitis co-infection. Specifically, we analyze results from semi-structured interviews with health care providers (N=23) and Asian Americans who are HIV and hepatitis (HBV and/or HCV) co-infected (N =17) in order to clarify how stigma in particular may impede/limit access to coordinated health care provision. Providers and clients recognize the need for integrated, culturally and linguistically appropriate access to care while simultaneously acknowledging that stigma is a severe barrier to access to care. This article sheds light on the complexities of the stigma experienced by HIV and hepatitis co-infected Asian Americans and suggests a need for further research and renewed efforts by caregivers to reduce stigma in these communities.

A Qualitative Study of Barriers to Enrollment into Free HIV Care: Perspectives of Never-in-Care HIV-Positive Patients and Providers in Rakai, Uganda

“…Stigma as a perceived barrier to using HIV care services is consistent with findings from other studies that implicated HIV-related stigma and discrimination toward people living with HIV (PLWH) as a barrier to HIV care [20–26]. This suggests that three decades into the HIV epidemic, stigma still remains central in the experiences of PLWH.…”

Correlates of hepatitis B virus-related stigmatization experienced by Asians: A scoping review of literature

“…Most studies focused on knowledge of and attitudes about HBV. Only three studies[242526] focused on stigma as the primary purpose of the research. In the cross-sectional surveys reviewed, only three studies[242627] included dimensions of stigma.…”

“…Chinese people in China and in the USA were the most studied groups. [242526272829303132333435] The participants were HBV-infected patients, members of the general community, health-care providers, or community leaders [Tables 1 and 2]. All participants were adults.…”

“…Stigma prevented both individuals and their family members to disclose the presence of HBV infection because they feared discrimination from the society. [152528313233343738] Reports of indicators of stigma ranged from 24%[36] to 70%. [39] In most studies, stigma was regarded as a dimension of knowledge of and/or attitude about HBV.…”

“…[1535] The findings of qualitative studies indicated that HBV-related stigma is a serious barrier to accessing services. [2533] It was found that HBV-positive individuals were more likely to disclose to the family but reluctant to disclose their condition to friends and coworkers. [2832] Two studies reported that the individuals who did not disclose their HBV status to others reported higher perception of stigma.…”