Tina A. Huynh, Aleta Baldwin, C. Junda Woo, Sean L. Greene, Gregory L. Casillas, Barbara S. Taylor, Katelyn M. Sileo
Background: People living with HIV and those at elevated risk for HIV, including some in the LGBTQ+ community, disproportionately experience negative health outcomes due to stigma encountered within healthcare. Improving healthcare quality for these populations requires addressing stigma within medical systems, institutions, and among providers.
Methods: As part of a larger, community-based participatory research project, the aim of this qualitative study was to identify strategies to reduce HIV and LGBTQ+ stigma in healthcare settings in San Antonio, TX. Academic researchers and a community-based organization, the End Stigma End HIV Alliance (ESEHA), conducted focus group interviews with healthcare professionals in San Antonio in 2020 (N=18). Data were analyzed using thematic analysis, guided by the social ecological model.
Results: Recommendations to reduce stigma spanned all levels of the social ecological model. Multi-level educational interventions were recommended, including storytelling performances at the interpersonal level, and community-level campaigns to destigmatize HIV and increase LGBTQ+ representation. Key recommendations at the organizational-level included mandatory continuing medical education, resource guides, standardizing inclusive intake forms and single-capture histories, along with other efforts to change workplace culture through team training and collectivistic leadership approaches.
Conclusions: These findings highlight tangible, multi-level stigma solutions to improve healthcare quality for people living with HIV and the LGBTQ+ community. An ESEHA working group used these findings in tandem with findings from other elements of the larger project (i.e., quantitative survey, storytelling project), and a literature review of evidence-based stigma reduction strategies, to create stigma reduction guidelines for dissemination to local healthcare organizations.