Dentistry and HIV/AIDS related stigma

Elizondo, Jesus Eduardo; Treviño, Ana Cecilia; Violant, Deborah

doi:10.1590/S0034-8910.2015049005877

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005877 copy

Dentistry and HIV/AIDS related stigma

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To analyze HIV/AIDS positive individual’s perception and attitudes regarding dental services.

METHODS

One hundred and thirty-four subjects (30.0% of women and 70.0% of men) from Nuevo León, Mexico, took part in the study (2014). They filled out structured, analytical, self-administered, anonymous questionnaires. Besides the sociodemographic variables, the perception regarding public and private dental services and related professionals was evaluated, as well as the perceived stigma associated with HIV/AIDS, through a Likert-type scale. The statistical evaluation included a factorial and a non-hierarchical cluster analysis.

RESULTS

Social inequalities were found regarding the search for public and private dental professionals and services. Most subjects reported omitting their HIV serodiagnosis and agreed that dentists must be trained and qualified to treat patients with HIV/AIDS. The factorial analysis revealed two elements: experiences of stigma and discrimination in dental appointments and feelings of concern regarding the attitudes of professionals or their teams concerning patients’ HIV serodiagnosis. The cluster analysis identified three groups: users who have not experienced stigma or discrimination (85.0%); the ones who have not had those experiences, but feel somewhat concerned (12.7%); and the ones who underwent stigma and discrimination and feel concerned (2.3%).

CONCLUSIONS

We observed a low percentage of stigma and discrimination in dental appointments; however, most HIV/AIDS patients do not reveal their serodiagnosis to dentists out of fear of being rejected. Such fact implies a workplace hazard to dental professionals, but especially to the very own health of HIV/AIDS patients, as dentists will not be able to provide them a proper clinical and pharmaceutical treatment.

HIV Long-Term Survivors; Dental Health Services; Health Knowledge, Attitudes, Practice; Prejudice; Social Discrimination; Health Inequalities; Psychometrics; Mexico

Variable	Women			Men			p^a

	Mean	SD	Median	Mean	SD	Median
Age (years)	41.7	10.9	41^b	34.9	8	34^b	< 0.0001
HIV (years of diagnose)	6.10	5.51	5^d	3.19	4.18	2^d	< 0.001
Education level (years of schooling)	8.4	4.1	9^b	14	3.5	15^b	< 0.0001

Sexual orientation	n	%		n		%
Homosexual	0	0		83		88.3^b,c	< 0.0001
Bisexual	0	0		9		9.6
Heterosexual	40	100^b,c		2		2.2
Workload
Full-time	16	40.0		77		81.9^b,c	< 0.0001
Part-time	0			10		10.6
Does not work	24	60.0^b,c		7		7.4
Monthly income
≤ 15,000 MXN (1,146 USD)	40	100^c		65		69.2^b,c	< 0.0001
≤ 30,000 MXN (2,292 USD)	0	0		22		23.4
> 30,000 MXN (2,292 USD)	0	0		7		7.5

Variable	Women		Men		p^a

	n	%	n	%
How many times a year do you have dental appointments?
None	11	28.9	0	0
Once a year	17	44.7^c	47	50.0	< 0.001
Twice or more a year	10	26.3	47	50.0
Do you have appointments in a public or in a private dental office?
None	11	28.9	0	0
Public	15	39.5^b	24	25.5
Private	12	31.6	70	74.5^b,c	< 0.001
Do you have appointments with a general or with a specialty dentist?
None	2	5.7	0	0
I do not know	13	37.1^b	25	26.6
General	11	31.4	38	40.4^b,c	< 0.001
Specialty	9	25.7	31	33.0
Among the following options, which is the most similar to the main reason why you select a certain dentist?
Knowledge	12	32.4^b,c	25	26.6
Experience	5	13.5	28	29.8^b,c	< 0.001
Formality	3	8.1	6	6.4
Price	5	13.5	11	11.7
Good chairside manner	7	18.9	7	7.4
Office appearance	1	2.7	6	6.4
Office hygiene	2	5.4	8	8.5
Dentist’s personal appearance	2	5.4	3	3.2

Variable	Women		Men		p^a

	n	%	n	%
Is the dental office you have appointments in safe, clean, and complying with infection-control regulations?
Yes	11	27.5	86	91.5^b,c	< 0.001
No	29	72.5^b,c	8	8.5
Do you trust your dentist to keep the confidentiality of the information in your dental record?
Yes	21	58.3^c	64	68.1^c	< 0.001
No	15	41.7	29	30.9
Do you believe it is important that your dentist be qualified to treat HIV patients?
Yes	33	84.6^c	86	91.5^c	< 0.001
No	6	15.4	8	8.5
Have you informed your dentist of your HIV status?
Yes	19	48.7	29	30.9
No	20	51.3	65	69.2^c	< 0.001
Do you think it is important that you tell your dentist you live with HIV?
Yes	24	61.5^c	74	78.7^c	< 0.001
No	15	38.5	20	21.3
I have a right not to disclose my HIV status, and that is why I do not tell it to my dentist:
Yes	26	65.0^b	66	70.3^c	< 0.001
No	14	35.0	28	29.8
I am afraid to be denied dental care, and that is why I do not tell my dentist I live with HIV:
Yes	25	62.5^c	64	68.1^c	< 0.001
No	15	37.5	30	31.9
I am afraid of the inconveniences that may arise in dental care, and that is why I do not tell my dentist I have HIV:
Yes	25	62.5^b,c	41	43.6	< 0.001
No	15	37.5	53	56.4^b,c
Do you think dentists in general are health care professionals who follow ethical principles, and because of that, they treat you like any other patient, regardless of whether you are HIV positive or not?
Yes	16	43.2	76	80.9^b,c	< 0.001
No	20	54.1^b	18	19.1
I do not know	1	2.7	0	0
Do you believe HIV/AIDS can be transmitted in dental offices?
Yes	13	33.3	42	44.7
No	26	66.7^b	51	54.3^c	< 0.001
I do not know	0	0	0	0
Do you believe your dentist may transmit HIV?
Yes	5	12.5	16	17.0
No	34	85.0^c	78	83.0^c	< 0.001
I do not know	1	2.5	0	0
Do you believe you can transmit HIV to your dentist?
Yes	10	25.6	31	33.0
No	29	74.4^c	50	53.2^c	< 0.001
I do not know	0	0	13	13.8
Do you believe you can transmit HIV to other people going to the same dental office or clinic?
Yes	9	22.5	18	19.1
No	31	77.5^c	75	79.7^c	< 0.001
I do not know	0	0	0	0
Do you believe you can catch a secondary infection during or after being treated in a dental office or clinic because you have HIV?
Yes	13	33.3	37	39.4
No	24	61.5^c	57	60.7^c	< 0.001
I do not know	2	5.1	0	0
Do you believe people living with HIV must only seek care in dental offices or clinics which are exclusive to HIV patients?
Yes	15	38.5	21	23.3
No	24	61.5^c	73	77.7^c	< 0.001
I do not know	0	0	0	0
Do you believe oral illnesses affect your general state of health?
Yes	35	87.5^c	63	67.0^c	< 0.001
No	5	12.5	31	33.0
I do not know	0	0	0	0
How do you appraise your overall oral health?
Excellent	8	20.5	6	6.4
Good	28	71.8^c	40	42.6^c	< 0.001
Fair	1	2.6	36	38.3
Poor	2	5.1	12	12.8
I do not know	0	0	0	0

Items	Never		Rarely		Occasionally		Often		Very often

	n (%)		n (%)		n (%)		n (%)		n (%)

	W	M	W	M	W	M	W	M	W	M
Have you ever been discriminated by a dentist because you live with HIV?	25 (69.4)	79 (84.0)	4 (11.1)	8 (8.5)	4 (11.1)	5 (5.3)	2 (5.6)	1 (1.1)	1 (2.8)	1 (1.1)
Over the last 12 months, how often were you denied dental care for being HIV positive?	31 (79.5)	85 (90.4)	3 (7.7)	7 (7.4)	5 (12.8)	1 (1.1)	0	1 (1.1)	0	1 (1.1)
When you go to a dental office or clinic, has any one given you a reason for denying you dental care services cos you are HIV positive?	30 (76.9)	78 (83.0)	2 (5.1)	10 (10.6)	4 (10.3)	3 (3.2)	3 (7.7)	2 (2.1)	0	1 (1.1)
When you go to a dental office or clinic, does it take you longer to be treated than other patients?	27 (69.2)	81 (86.2)	3 (7.7)	5 (5.3)	6 (15.4)	5 (5.3)	2 (5.1)	2 (2.1)	1 (2.6)	1 (1.1)
When you go to a dental office or clinic, do you notice whispers, glances, or laughter towards you?	31 (81.6)	78 (83)	0	9 (9.6)	4 (10.5)	5 (5.3)	3 (7.9)	2 (2.1)	0	0
Have you ever been made to fell blamed, undermined, or belittled for having HIV whilst being treated in a dental office or clinic?	31 (81.6)	83 (88.2)	1 (2.6)	4 (4.3)	3 (7.9)	5 (5.3)	1 (2.6)	0	2 (5.3)	2 (2.1)
Have you ever been given negative opinions about your lifestyle or sexual behaviors whilst being treated in a dental office or clinic?	30 (78.9)	82 (87.2)	0	6 (6.4)	5 (13.2)	5 (5.3)	2 (5.3)	1 (1.1)	1 (2.6)	0
Have you ever been treated with disdain, indifference, or criticism whilst being treated in a dental office or clinic?	29 (74.4)	82 (87.2)	3 (7.7)	6 (6.4)	4 (10.3)	6 (6.4)	1 (2.6)	0	2 (5.1)	0
Has anyone ever avoided getting in contact with your skin whilst being treated in a dental office or clinic?	29 (78.4)	84 (89.4)	1 (2.7)	7 (7.4)	3 (8.1)	2 (2.1)	2 (5.4)	1 (1.1)	2 (5.4)	0
Has anybody ever behaved in a way to display fear or insecurity at the time they had to dress wounds, apply sutures, injections, or other dental procedures during treatment in a dental office or clinic?	29 (74.4)	82 (87.2)	0	7 (7.4)	7 (17.9)	2 (2.1)	1 (2.6)	2 (2.1)	2 (5.1)	1 (1.1)
Whilst being treated in a dental office or clinic, has anybody ever requested that the materials used in your treatment be discarded, based on the argument that your HIV-positive status offered a higher risk?	29 (76.3)	83 (88.3)	1 (2.6)	7 (7.4)	2 (5.3)	0	2 (5.3)	1 (1.1)	4 (10.5)	3 (3.2)

Items	Means and correlation matrix
Items	Mean	1	2	3	4	5	6	7	8	9	10
a	0.338
b	0.185	0.583
c	0.308	0.661	0.589
d	0.346	0.514	0.305	0.579
e	0.323	0.574	0.462	0.658	0.663
f	0.431	0.522	0.523	0.567	0.545	0.758
g	0.285	0.540	0.484	0.541	0.596	0.822	0.713
h	0.262	0.456	0.431	0.537	0.525	0.776	0.676	0.790
i	0.238	0.516	0.432	0.554	0.541	0.803	0.741	0.802	0.880
j	0.308	0.539	0.506	0.543	0.555	0.804	0.747	0.771	0.823	0.819
k	0.308	0.529	0.405	0.469	0.491	0.470	0.613	0.472	0.495	0.472	0.636

	Rotated component matrix
Items	Factor 1. Non personal disparagement experiences from dentists or their staff				Factor 2. Non concern with dentists or their staffs’ attitudes				Commonalities

a	0.286				0.821				0.756
b	0.207				0.785				0.659
c	0.368				0.768				0.725
d	0.552				0.458				0.514
e	0.822				0.402				0.838
f	0.719				0.456				0.726
g	0.834				0.337				0.809
h	0.890				0.239				0.849
i	0.891				0.271				0.868
j	0.831				0.378				0.833
k	0.422				0.569				0.502
Eigenvalues	7.049				1.030
Percentage of explained variance	64.079				9.361

	Distances between final cluster centers
Cluster	1. Users who have not experienced HIV-related stigma and discrimination in dental appointments.				2. Users who have not experienced stigma and discrimination, but feel slightly concerned about dentists or their staffs’ reaction regarding their HIV+ serodiagnosis.				3. Users who have experienced HIV-related stigma and discrimination, and feel concerned about dentists and their staffs’ reaction regarding their HIV+ serodiagnosis.

	85.0% (n = 114)				12.7% (n = 17)				2.3% (n = 3)
1					9.434				5.292*
2	9.434								4.394*
3	5.292				4.394

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Jesús Eduardo Elizondo Grupo de investigación en Biofármacos e Ingeniería Biofarmacéutica Escuela Nacional de Posgrado en Ciencias e Ingeniería Instituto Tecnológico de Monterrey Avenida Eugenio Garza Sada 2501 Sur Colonia Tecnológico, Monterrey, Nuevo León 64849 CP, México E-mail: je.elizondo.phd.mty@itesm.mx