Using Mindful Communication to Confront HIV-Related Stigma in Patient-Provider Interactions

Background: The lives of African American and Latino gay and bisexual men matter; every new infection of HIV and STDs is one too many. This population depends on competent health care providers. Stigma and HIV have long been intertwined, and using effective communication techniques to uncouple the two is challenging. Lambda Legal reports that two thirds of people living with HIV (PLWH) report experiencing one of the following forms of discrimination from health care providers: Refused to touch the patient or used excessive precautions; blamed the patient for their health status; used harsh or abusive language; or was physically rough or abusive. 

Program background: Clinical providers have a critical role to play in improving the health outcomes of African American and Latino gay and bisexual men. Gay patients are likely to assume that medical providers see them through a lens of bias until trust is established and maintained. Some of this mistrust is rooted in hearsay and myth. However, the mistrust itself has a real and lasting impact. It is central to the quality of the provider-patient relationship. Addressing the patient’s unsaid concerns can help a medical provider build trust. Trust can increase the patient’s adhere to their treatment recommendations and, ultimately, that individual’s health outcomes.

Evaluation Methods and Results: This presentation outlines mindful communication decision-making principles aimed at guiding the development of an effective anti-stigma communications approach. It focuses on understanding how HIV-related stigma operates in patient-provider relationships, the role that communication plays in eliminating it, and tools to foster mindful communication. The session strategizes pragmatic steps that providers can take in their everyday roles and interaction with patients to build trust with men who identify as gay or bisexual. In particular, the guided conversation addresses: (1) issues of language for improved patient interactions with African American and Latino gay and bisexual men; (2) clinical process recommendations to foster “safe spaces” and de-stigmatizing environments; (3) standard of care updates for this population and the role that stigma plays in their dissemination and recommended implementation; and (4) resources to proven approaches that address the challenges outlined in the discussion.

Conclusions: To successfully address HIV, professionals in the field need approaches for addressing HIV-related stigma that include more mindful communication regarding people living with and impacted by HIV. The language that providers use defines how we work with clients. For better or worse, how we communicate about HIV impacts how policy is shaped, how programs are developed and implemented, and how individual behavior plays out at the community level. 

Implications for research and/or practice: Through this session, participants will an experiential understanding on how to be a mindful communicator, and will provide concrete examples to examine how stigmatizing language such as “at-risk” or “hard-to-reach” operates in the context of vulnerable communities, to help us understand their unintended “othering” consequences. This framework of communication principles can also be applied at every level of communication processes, from social marketing design, cultural competency and program delivery curricula, to modeling everyday communication with peers and clients.