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An Incognito Standardized Patient Approach for Measuring and Reducing Intersectional Healthcare Stigma: A Pilot

M Kumi Smith¹, Danyang Luo², Siyan Meng³

¹Division of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis, MN.

Journal of Acquired Immune Deficiency Syndromes (1999)

|February 5, 2025

Summary

Stigma reduction training for healthcare providers in China improved care for some groups, but further clinical content is needed to better support people living with HIV (PLWH). This study highlights the need for tailored interventions to reduce healthcare disparities.

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Area of Science:

Public Health
Healthcare Disparities
Medical Training

Background:

Stigma significantly hinders healthcare access for people living with HIV (PLWH) and men who have sex with men (MSM).
Provider behaviors in clinical settings were directly observed using standardized patients (SPs) to inform intervention design.

Purpose of the Study:

To evaluate the impact of a stigma reduction training program for healthcare providers.
To assess the feasibility, acceptability, and preliminary efficacy of the intervention in reducing stigma-related disparities in care quality.

Main Methods:

A pilot cluster randomized controlled trial was conducted in sexually transmitted disease clinics in Guangzhou, China.
Standardized patients presented varied HIV statuses and sexual orientations to quantify care quality differences.
Linear fixed effects regression was used to assess the impact of the intervention through follow-up SP visits.

Main Results:

The training demonstrated high feasibility and acceptability among 55 provider participants.
Improvements were observed in offering testing to HIV-negative MSM and diagnostic effort for HIV-positive MSM.
Patient-centered care improvements were noted primarily for HIV-positive heterosexual cases; all estimates lacked statistical precision.

Conclusions:

The stigma reduction training showed positive effects in several care domains but was least effective for PLWH.
Future training initiatives should incorporate more clinical content to enhance management skills for PLWH.
Targeted interventions are crucial for mitigating stigma and improving healthcare equity for vulnerable populations.