UCLA Study Finds High Rates of HIV Discrimination in Health Care

  1. ucla study finds high rates of hiv discrimination in health care

    one-fourth to one-half of skilled nursing facilities, obstetricians, and cosmetic surgeons in la county deny treatment to hiv-positive patients

    los angeles, california-- january 29, 2007-- the williams institute on sexual orientation law and public policy released a study today showing surprisingly high rates of hiv discrimination by health care providers in los angeles county. the study reports findings from three "testing" studies of skilled nursing facilities, obstetricians, and cosmetic surgeons conducted between 2003 and 2005.

    overall, 56% of skilled nursing facilities, 47% of obstetricians, and 26% of plastic and cosmetic surgeons in los angeles county would not accept hiv-positive patients for services commonly offered to hiv-negative patients. for example, when asked if he accepted hiv-positive patients, one health care worker responded, "we try not to.i'm just trying to be honest."

    "the large number of health care providers who would readily admit that they would not treat hiv-positive patients is surprising," said brad sears, executive director at the williams institute and author of the study. "their responses indicate a broad lack of knowledge about the laws prohibiting such discrimination."

    "while the united states has made great advances during the past decade in treating hiv-disease, this study shows that we lag behind in eradicating hiv-discrimination," said lee badgett, williams institute research director.

    the new report is consistent with studies from the mid-1990s showing high levels of hiv-discrimination by dentists and other health care providers. since the late 1990s, very few studies have been done to measure hiv-discrimination in health care.

    the studies were conducted by trained "testers," 3rd-year ucla law students posing as either hiv-positive patients or as employees of organizations working with such patients. using a script, the testers called the offices of local health care providers and asked if they would accept hiv-positive patients. the testers then recorded and coded the responses.

    the three types of health care providers included in the study were chosen based on current medical needs of persons living with hiv/aids, including nursing care as the hiv-population ages, cosmetic surgery to address the impact of facial wasting, and prenatal care for women living with hiv/aids. the study focused on determining the percentage of providers in each area who had a blanket policy of refusing services to people with hiv/aids.

    the study also provides insight into why health care providers refuse to see hiv-positive patients. some providers justified their policies by their lack of expertise or medical equipment, the fact that they had never treated an hiv-positive patient before, or that their staff were inadequately trained or would "revolt" if asked to treat hiv-positive patients.

    many providers follow a blanket policy of referring all hiv-positive patients to other providers, most frequently by just telling them they need a "specialist" or to "go to a hospital." state and federal law require that such referrals be made on a case-by-case basis after providers have gathered specific information about the health and health care needs of the prospective patient.

    "many providers are refusing to treat hiv-positive patients and are referring them elsewhere in violation of the ethical rules of their own professional associations," says sears. "in a couple of cases, the testers followed up on the initial referrals, only to be referred on again and again in a frustrating trail that ended with an absolute refusal of care."

    "the study indicates that strengthening current laws prohibiting hiv discrimination may not be enough," says badgett. "we have laws on the books already. the problem may be inadequate training of heath care professionals about hiv-disease and their legal obligations, as well as a lack of enforcement."

    the williams institute on sexual orientation law and public policy advances law and public policy through rigorous, independent research and scholarship, and disseminates its work through a variety of education programs and media to judges, legislators, lawyers, other policy makers and the public. this study can be accessed at the williams institute website: www.law.ucla.edu/williamsinstitute
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  2. 12 Comments

  3. by   oramar
    I am somewhat puzzled about plastic surgeons refusing HIV patients. How do they know? To my knowledge they don't routinely test for it. Half their cases could be positive and they would not have a clue if the patient did not know. Obstetrics is different of course, they have reason to do routine testing.
  4. by   GardenDove
    I don't think it has anything to do with sexual orientation. I would presume that anyone doing surgery on an HIV pt would be nervous about needlesticks. That would be my greatest concern.
  5. by   GardenDove
    I would think anytime you might be suturing, you'd be at risk, such as plastic surgery, periniel suturing, or any surgery.
  6. by   caroladybelle
    Quote from GardenDove
    I would think anytime you might be suturing, you'd be at risk, such as plastic surgery, periniel suturing, or any surgery.
    Yet surgeons do not routinely test for HIV.

    Plastics are at less risk than say orthos or neuros, yet they (ortho/neuros) do not test, nor in most even ask HIV status.
  7. by   GardenDove
    Quote from caroladybelle
    Yet surgeons do not routinely test for HIV.

    Plastics are at less risk than say orthos or neuros, yet they (ortho/neuros) do not test, nor in most even ask HIV status.
    I wonder what the rate of needlesticks is during surgery, while suturing?
  8. by   caroladybelle
    Quote from GardenDove
    I wonder what the rate of needlesticks is during surgery, while suturing?
    Orthos/neuros not only suture, they saw through bone, and manipulate sharp bones, and in very tiny spaces, placing rods and screws. Also using saws, drills.
  9. by   GardenDove
    Quote from caroladybelle
    Orthos/neuros not only suture, they saw through bone, and manipulate sharp bones, and in very tiny spaces, placing rods and screws. Also using saws, drills.
    Honestly, I can understand their concern. I doubt if it's anything to do with sexual preferance, but the nature of the virus and it's devastating potential.
  10. by   caroladybelle
    I worked an HIV unit right out of school.

    I feel more in danger on M/S units where they are careless w/ MRSA, VRE, C.Diff.

    It is not that easy even with a direct bloody stick to get HIV. When you consider that surgeons work in a much more controlled environment than nurses, nurses are probably more at risk.
  11. by   GardenDove
    Quote from caroladybelle
    I worked an HIV unit right out of school.

    I feel more in danger on M/S units where they are careless w/ MRSA, VRE, C.Diff.

    It is not that easy even with a direct bloody stick to get HIV. When you consider that surgeons work in a much more controlled environment than nurses, nurses are probably more at risk.
    I don't personally feel threatened by MRSA, C-diff, etc because I have a high degree of health and intact immune system. I do feel like it is a huge risk to my vulnerable pts if I carry it from room to room. I wouldn't be a vulnerable host, but they would. I'm not sure if HIV has that opportunistic character, however. I think either you get it or you don't, and it silently starts mutating your helper T-cells even when you're in a high state of health.

    There were some studies in Africa of some prostitutes who were repeatedly exposed to HIV, but had a natural immunity. Have you read about that?
  12. by   morte
    Quote from GardenDove

    There were some studies in Africa of some prostitutes who were repeatedly exposed to HIV, but had a natural immunity. Have you read about that?
    yes, i have, and have oft wondered why they werent the center of a big study....
  13. by   oramar
    Quote from morte
    yes, i have, and have oft wondered why they werent the center of a big study....
    I had heard that some people have a type of cell structure that does not give the HIV virus a place to hook on to the cell. These people are infact immune. However, I do not know if this group of people are included in that finding.
  14. by   CamIam
    I don't know about the Africa study (well I know there was a study, just don't know the details), but I worked in HIV clinical research for a few years. There are some very interesting patients that are part of a long term (30 year) study who tested positive for the HIV virus in the early 80's and have never become ill or had any drop in T-cells or rise in viral load above 1000 copies (the cut off for a CDC aids diagnosis). They're called "chronic non-progressors" and they are studied with great interest as a potential link to a vaccine.

    As far as the earlier comment about being more afraid of MRSA etc, I have a superhuman immune system (by experience and my doctor's account) and managed to come down with MRSA within 3 months of returning to direct patient care in an inner city hospital. You have a better chance of being shot on the street than of contracting HIV from a needle stick--I believe at last look (probably in 2006) the statistics were that of 100,000 needle sticks relating to an HIV positive patient, none of them seroconverted regardless of whether or not they went on PEP afterwards. None of them.

    I work in a hospital where I am constantly shocked by the amount of ignorance and misinformation about HIV and it's transmission--CNA's posting "contact isolation" signs, or gowning and gloving before entering the room of HIV patients. Doctors double gloving just to interview patients. Amazing.

    The funding for HIV education (and treatment for that matter) is dwindling by the year. It's too bad--we really do people a disservice by not becoming less ignorant. It just fosters the prejudice, that it's a "gay white man's disease" (which I can attest is completely untrue having worked in the gay and the african american and the IVDA communities) and that all people with HIV should be treated like they are untouchable.

    Boo for us as caregivers that we don't all make an effort to be more informed.

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