August 1, 2008

Discrimination Doesn’t Worsen Treatment Adherence

Poorer antiretroviral (ARV) therapy adherence among HIV-positive people of color cannot be explained by experiences of discrimination or distrust in health care settings, conclude the authors of a study published online July 23 in the Journal of Acquired Immune Deficiency Syndromes.

A number of studies have found that HIV-positive racial and ethnic minorities have poorer adherence to ARV treatment than white patients and that the differences can not be explained by common causes of non-adherence such as depression, drug use or economic status.

To examine whether experiences of discrimination and distrust in the health care system may help explain poorer adherence among minorities, Angela Thrasher, PhD, MPH, from the University of California San Francisco’s School of Medicine, and her colleagues examined data gathered through the HIV Cost and Services Utilization Study (HCSUS). Thrasher’s team included data from 1,886 people living with HIV who had initiated ARV therapy. Compared with white patients, minority patients were more likely to be female and to rely on government programs to pay for their health care.

As with other studies, Thrasher’s team found that minority patients had poorer self-reported adherence to ARV treatment than white patients. Interestingly, however, roughly the same number of white and minority patients reported experiences of discrimination in the health care setting and distrust of health care providers. This meant that such experiences and feelings toward health care providers could not explain the difference in the level of adherence between whites and minorities.

The authors are careful to explain that while experiences of racial and ethnic discrimination can affect a person’s well-being, focusing on discrimination as a way to improve adherence may not be effective.

Search: minority, race, ethnicity, discrimination, adherence, Angela Thrasher, UCSF

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