Stigmatizing clinical setting erodes physician-patient interaction quality for sexual minority men through perceived HIV stigma and HIV infection concerns in Zambia

ABSTRACT

This study investigated whether perceived HIV stigma and HIV infection concerns among healthcare providers (HCPs) mediate the association between stigmatizing clinical setting and their interaction quality with sexual minority men (SMM) patients in Zambia. In 2021, a cross-sectional survey was conducted with 91 HCPs offering HIV-related services to SMM in Zambia. Path analysis was conducted to examine the potential mediation effect of “perceived HIV stigma” and “HIV infection concern” among HCPs in the association between “stigmatizing clinical setting” and their “interaction quality with SMM”. Mediators i.e., “perceived HIV stigma” and “HIV infection concern” among HCPs, were associated positively with the stigmatizing clinical setting (β = 0.329, p < .01, β = 0.917, p < 0.01), and negatively with physician-patient interaction quality (β = −0.167, p = 0.051; β = −0.126, p < 0.05). Stigmatizing clinical setting had a significant and negative indirect effect on HCPs interaction quality with SMM through increased perceived HIV stigma (z = −1.966, p < 0.05) and increased HIV infection concern (z = −1.958, p = 0.050). To improve physician-patient interaction quality, stigma reduction interventions among HCPs, who serve SMM in Zambia, should target development of development of inclusive policies and the cultivation of cultural norms that are supportive and respectful to SMM, and protection of HCPs from enacted stigma due to offering care to SMM.

KEYWORDS:

• Sexual minority men (SMM)
• perceived HIV stigma
• physician-patient interaction
• HIV prevention
• HIV infection concern
• stigmatizing clinical setting in HIV facilities

Sustainable Development Goals:

• SDG 3: Good health and well-being
• SDG 10: Reduced inequalities
• SDG 5: Gender equality

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data is available on request to the corresponding author.

Additional information

Funding

This work was supported by National Institutes of Health: [Grant Number R21TW].