Unlocking Access: Experience of Discrimination and Differential Care Surrounding Trauma and Acute Care Surgery in People Living with Human Immunodeficiency Virus in a Middle-Income Country
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Background
This observational study aims to identify areas of delayed and differential care, and describe perceived challenges to accessing surgery for people living with human immunodeficiency virus (PLHIV).
Methods
An exploratory sequential, observational mixed-methods study, conducted from 2022-2023, in a public hospital in Lima, Peru, included semi-structured interviews with PLHIV and surgeons that informed a survey to describe their perspectives on access to surgical care.
Results
Fifteen PLHIV and seven surgeons were interviewed, and 118 surgeons were surveyed. Results were organized by: 1) access to care, 2) patient disclosure, 3) differential treatment for PLHIV, and 4) improvement strategies. PLHIV perceived delayed care resulting from unclear additional presurgical requirements leading to stigma and unexpected costs. Refusal of care made PLHIV feel rejected, disrespected, and discriminated against. For surgeons, mandatory HIV testing was perceived as controversial and beneficial but problematic due to lack of lab resources. PLHIV reported their willingness to disclose was related to their understanding of their disease, particularly knowledge regarding disease transmission. Few surgeons interviewed perceived they provided differential treatment for PLHIV, however, in surveys when comparing surgical practices on PLHIV vs. non-PLHIV (such as double gloving, use of mask/goggles and avoiding extra collaborators while operating), there was a significant difference (p<0.05). Both interviews and surveys revealed that providers educational interventions could potentially reduce differential care and surgery delays.
Conclusions
Unclear presurgical requirements delay treatment and lead to unexpected costs. Educational interventions across all specialties, not just surgery, could reduce stigma and help fostering a more inclusive and safer environment for PHLIV.
