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48th Annual ICAAC / IDSA 46th Annual Meeting
October 25-28, 2008
Washington, DC
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Half of Black US Women Switch HIV Clinicians Because of Communication Problems
  48th ICAAC
October 25-28, 2008
Washington, DC
Mark Mascolini
Half of black women in a study of 700 antiretroviral-treated women changed their physician because they believed communication problems hampered their treatment, a rate significantly higher than among Hispanic or white women [1]. Black and Hispanic women in the survey were more likely than white women to feel that race or ethnicity affected their overall care. The findings must be interpreted cautiously, however, because of the methods used to sign up women for this study.
Researchers recruited HIV-infected women from a US national network of AIDS counseling centers through flyers left at the centers. Participants called a toll-free number and answered questions during a 15-minute structured interview. They got $25 for their effort.
Blacks and Hispanics account for almost 80% of newly diagnosed HIV infection in US women today. The 700 survey respondents included 300 blacks, 200 Hispanics, and 200 whites. They averaged 42.5 years in age, and 42% were at least 45 years old. More women came from the South (33%) and Northeast (30%) than from the Midwest (21%) or West (16%). Women knew they had HIV infection for an average 10.6 years and had taken combination antiretroviral therapy for an average 8.1 years. All had taken antiretrovirals for at least 3 years. Significantly more black women (41%) and Hispanic women (40%) had children than did white women (30%) (P < 0.05).
Black and Hispanic women were significantly more likely than whites to believe their culture, ethnicity, or language affected the care they received "a lot": 38% of blacks, 40% of Hispanics, and 27% of whites (P < 0.05)
. Compared with whites, more blacks and Hispanics also felt these factors affected their care "a little": 21% of blacks, 32% of Hispanics, and 10% of whites (P < 0.05). Women in the South were significantly more likely than women in the West or Northeast to believe culture, ethnicity, or language affected their care "a lot" (44% versus 25% and 33%, P < 0.05).
Women seeing a family physician or general practitioner were significantly more likely than those seeing an infectious disease specialist or a nurse practitioner or physician's assistant (PA) to feel that culture, ethnicity, or language affected their care "a lot" or "a little" (76% versus 53% and 49%, P < 0.05). In contrast, 51% of women seeing a nurse or PA switched providers because of perceived communication problems, compared with 45% seeing a family physician or generalist and 38% seeing an infectious disease physician.
The survey found that 433 women (60%) switched clinicians during treatment for HIV, and 292 of these 433 (43%) switched because of poor communication with their provider. While 33% of white women and 37% of Hispanic women changed clinicians because of communication problems with their provider, 47% of black women did (P < 0.05).
The researchers believe their findings highlight "a need for heightened awareness of ethnic and cultural issues that influence a patient's interaction with health care providers and satisfaction with her medical care."
Women who responded to this survey may not represent all US women with HIV, first, because they attended an AIDS counseling center and, second, because they self-selected themselves by picking up the survey flyer and calling the toll-free number. Because of these factors, respondents may be more involved in their health care or more dissatisfied with their care than the general US population of women with HIV.
1. Hodder S, Aberg J, Feinberg J, et al. Perceptions of care by HIV-infected women in the United States. 48th Annual International Conference on Antimicrobial Agents and Chemotherapy (ICAAC). October 25-28, 2008. Washington, DC. Abstract H-445.