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Starting HIV Care

CE / CME

Starting in Care: Ensuring HIV Services Are Inclusive and Equitable

Nurses: 0.75 Nursing contact hour

Pharmacists: 0.75 contact hour (0.075 CEUs)

Physicians: maximum of 0.75 AMA PRA Category 1 Credit™

Released: August 05, 2024

Expiration: August 04, 2025

CME/CE Information

Activity

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Course Completed

Racial Disparities in New HIV Diagnoses

The goal of this educational activity is to understand the best practices for creating a welcoming and inclusive environment for people with HIV in the clinical setting.

Before I share my best practices, I want to provide some context: We’ve come a long way over the past 40-plus years and have made significant progress. However, we've also lost an entire generation before effective antiretroviral therapy, and it is crucial to understand how this affects people with HIV. Knowing this historical context is essential for providing culturally competent and effective care.

Despite our progress, we are now faced with an epidemic marked by inequities and disparities, leading to varied outcomes by race, ethnicity, gender, sexual orientation, and geography. According to the CDC, 2022 epidemiological data from the United States and 6 territories indicate that HIV disproportionately affects communities of color, particularly Black and Latino/a communities, a trend that has been evident since the beginning of the epidemic.

We see significant disparities among people living with HIV and those newly diagnosed each year. This impact is especially pronounced among Black gay and bisexual men, and Black women, particularly those living in the South.1

These disparities are evident not only in new HIV diagnoses but also in HIV-related outcomes, such as viral suppression.2

It is crucial to keep these disparities in mind when we interact with people newly diagnosed with HIV.1  

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Social Determinants of Health for New HIV Diagnoses: US Data

The significant disparities in HIV incidence and related outcomes stem primarily from social determinants of health.

Our understanding has evolved over years of research, shifting focus from viewing HIV diagnosis solely as a consequence of individual behavior to recognizing the impact of structural and systemic factors and barriers to healthcare access. Factors such as poverty, lack of health insurance, limited access to education, and income disparities play crucial roles in influencing HIV-related outcomes and are critical considerations for people living with HIV.3

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HIV ACEs Pyramid: Relationship Between Trauma, Oppression, Risk Behaviors, and Progression of HIV 

In addition to social determinants of health, psychological factors such as intergenerational trauma, the impact of structural racism, and experiences of homophobia, transphobia, and discrimination within families, communities, and policies significantly influence HIV outcomes. 

Adverse childhood experiences (ACEs) is a term commonly used in pediatrics and mental health care for children. These are potentially traumatic events that can occur in childhood and adolescence. These influences can trace back to childhood experiences, including exposure to HIV-related deaths among relatives.

These factors collectively contribute not only to HIV infections but also to reduced quality of life, increased susceptibility to opportunistic infections, and higher mortality rates.4

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Stigma, Psychological Factors, and the HIV Care Continuum

The significance of stigma, depression, and other psychological factors, particularly the fear of contracting HIV, affects individuals across every stage of the HIV care continuum—from diagnosis and linkage to care, to retention in care, and ultimately achieving viral suppression.

It is crucial for clinicians and healthcare staff to recognize that these factors influence every part of this continuum, underscoring the need to address them early to enhance clinical outcomes for people with HIV.

Employing a trauma-informed approach that establishes a supportive environment from the outset of each appointment is important.

Many patients come in feeling anxious, so it is important to set expectations clearly and begin with open-ended questions that allow them space to express themselves. In clinical settings, patients are often interrupted too quickly. Therefore, instead of just focusing on medical issues, establishing a dialogue built on respect and empathy and exploring their social lives, psychological well-being, and family dynamics is crucial. Finding common ground helps providers connect with patients on a deeper level, in addition to acknowledging their resilience and achievements.

Starting with open-ended questions is key to understanding each individual's unique perspective and values before discussing their HIV diagnosis. Learning about their upbringing and life experiences provides context that shapes their identity.

Previous and ongoing traumatic experiences significantly influence outcomes across the HIV continuum, affecting whether a person contracts HIV, receives diagnosis, is linked to care, remains engaged in care, and achieves viral suppression. When coupled with conditions like substance use disorders and mental health issues, addressing trauma's impact at each stage of the continuum becomes essential.4

Click here to listen to Marc Thompson, a person living with HIV in London, England, as he describes his perspectives on best practices for the first visit. 

 

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Naming Discrimination

Considering the current state of the epidemic, it is crucial to acknowledge the impact of discrimination, racism, and other forms of structural violence that people with HIV encounter both within the community and in clinical settings.

Many individuals have faced these challenges prior to seeking care, making it important to directly inquire about their experiences with discrimination and how these experiences have affected them. This reparative approach aims to address and compensate for past negative healthcare encounters that people with HIV may not readily disclose, thereby establishing a clearer understanding of their needs from the outset.4

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