A new study led by recent University of Maryland PhD graduate Dr. Tanya Geiger and her doctoral advisor Dr. Bradley Boekeloo, professor of behavioral and community health in the University of Maryland School of Public Health, found that patient disclosure of HIV status is linked to engagement in medical care among low-income African Americans.
In 2014, African-Americans represented nearly half of all new HIV diagnoses in the United States, but only 41 percent of African-Americans living with HIV are engaged in medical care, according to the article published in AIDS and Behavior.
“While Blacks represent approximately 12 percent of the U.S. population, they represent nearly half of all new HIV diagnoses in 2014,” the study reported.
The UMD investigators examined the effect of disclosure among 262 African-Americans living with HIV who were recruited from community-based organizations as part of a program called Positive Pathways, a five-year intervention program initiated in 2011. The participants were 18 years or older and were recently diagnosed with HIV.
Dr. Geiger trained 10 clinical health workers to administer face-to-face interviews and assessments. The questions were based on 18 HIV stigma questions, which were used to collect data on the patients’ HIV disclosure. The participants were asked to indicate how much they agree with statements such as “I have lost friends by telling I have HIV” and “People avoid touching me if they know I have HIV.” The respondents could answer that the question does not apply to them because they had not told anyone they had HIV. The study also measured level of denial and assessed the subjects’ coping thoughts. After 90 days, the clinical health workers asked the participants whether they had had at least one HIV medical visit.
Based on the patients’ assessments, the study found that 78 percent of participants who had disclosed their HIV status at baseline attended at least one medical visit during the 90-day follow-up. Only 66 percent of participants who did not disclose their HIV status at baseline engaged in medical care. The study also revealed that 34 percent of the participants who did not disclose their HIV status were recently diagnosed.
“The impression from this and past studies is that nondisclosure is a strong predictor of lack of medical care because it is associated with a constellation of mental health and social factors such as denial, stigma and lack of social support that may hinder engagement in medical care,” the authors wrote.
One of the goals of the White House National HIV/AIDS Strategy for the United States is engagement in medical care among people living with HIV.
“It is important to establish seamless systems to link people to care immediately after diagnosis, and support retention in care to achieve viral suppression that can maximize the benefits of early treatment and reduce transmission risk,” Dr. Boekeloo said.
The UMD study, titled “‘HIV Serostatus Disclosure and Engagement in Medical Care Among Predominantly Low Income but Insured African Americans with HIV,” is published in AIDS and Behavior.