Eas.1,2 The southeast represents six southern states, including North Carolina, that are get L868275 disproportionately affected by the AIDS epidemic. In North Carolina, 68 of the total number of AIDS cases reported in 2007 were African Americans and 8 were Latinos.3 The rise of the AIDS epidemic in southeastern rural areas may be exacerbated by poverty and lack of access to HIV prevention and care that is more readily available in US urban areas.1,2 Such socioeconomic conditions create an environment that can engender HIV stigma and allow it to flourish. An extensive body of literature exists that identifies HIV stigma as a complex sociocultural barrier that negatively affects preventive behaviors, including condom use and HIV test-seeking behaviors; care-seeking behaviors relating to diagnosis and compliance; quality of care for people living with HIV/AIDS (PLWHA); and perception and treatment of PLWHA among family, friends, partners, health care providers, and the larger community.4,5 For example, in urban areas, HIV stigma was three times more likely to be associated with reduced access to care among low-income, HIV-infected individuals even after controlling for sociodemographic characteristics and biomarkers for HIV infection.6 For African Americans and Latinos living with HIV/AIDS in one of the southeastern states, stigma and shame have been identified as themes affecting medication adherence.7 These studies’ findings are of particular importance because lack of access, or delayed access to care, may result in more advanced stages of HIV disease at clinical presentation and/or increased resistance to first-line antiretroviral therapies. While qualitative and quantitative studies have demonstrated an association between HIV stigma and access to HIV care among racial/ethnic minority groups, little work has been done on the impact of HIV stigma on access to clinical trials. HIV clinical trials have been, and continue to be, a source of care for PLWHA, especially PLWHA who have no health insurance coverage. Racial/ethnic minority groups, however–particularly African Americans and Latinos–have been disproportionately underrepresented in HIV research and clinical trials despite formal policies and concerted efforts on the frontline to increase their inclusion as subjects in clinical trials.8,9 If HIV stigma is a barrier to HIV prevention and care services in impoverished and rural minority communities, it may also affect HIV clinical trial participation in these purchase BMS-791325 communities as well. Applying theory to understand the relationship between HIV stigma and HIV clinical trial participation in rural US communities will be useful in expanding our understanding of health disparities in HIV care access and utilization.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptN C Med J. Author manuscript; available in PMC 2011 February 11.Sengupta et al.PageIn recent years, theoretical frameworks have been posed to explore the complexity of HIV stigma and its impact in communities. The simplest theoretical framework breaks down HIV stigma into perceived stigma, experienced stigma, and internalized stigma.4 Perceived stigma is how PLWHA feel that they are being negatively treated by partners, family, friends, health care providers, and members of their community because of their HIV status. Experienced stigma is an act of discrimination towards PLWHA that includes denial of health care, education, or employment, or isolation from family me.Eas.1,2 The southeast represents six southern states, including North Carolina, that are disproportionately affected by the AIDS epidemic. In North Carolina, 68 of the total number of AIDS cases reported in 2007 were African Americans and 8 were Latinos.3 The rise of the AIDS epidemic in southeastern rural areas may be exacerbated by poverty and lack of access to HIV prevention and care that is more readily available in US urban areas.1,2 Such socioeconomic conditions create an environment that can engender HIV stigma and allow it to flourish. An extensive body of literature exists that identifies HIV stigma as a complex sociocultural barrier that negatively affects preventive behaviors, including condom use and HIV test-seeking behaviors; care-seeking behaviors relating to diagnosis and compliance; quality of care for people living with HIV/AIDS (PLWHA); and perception and treatment of PLWHA among family, friends, partners, health care providers, and the larger community.4,5 For example, in urban areas, HIV stigma was three times more likely to be associated with reduced access to care among low-income, HIV-infected individuals even after controlling for sociodemographic characteristics and biomarkers for HIV infection.6 For African Americans and Latinos living with HIV/AIDS in one of the southeastern states, stigma and shame have been identified as themes affecting medication adherence.7 These studies’ findings are of particular importance because lack of access, or delayed access to care, may result in more advanced stages of HIV disease at clinical presentation and/or increased resistance to first-line antiretroviral therapies. While qualitative and quantitative studies have demonstrated an association between HIV stigma and access to HIV care among racial/ethnic minority groups, little work has been done on the impact of HIV stigma on access to clinical trials. HIV clinical trials have been, and continue to be, a source of care for PLWHA, especially PLWHA who have no health insurance coverage. Racial/ethnic minority groups, however–particularly African Americans and Latinos–have been disproportionately underrepresented in HIV research and clinical trials despite formal policies and concerted efforts on the frontline to increase their inclusion as subjects in clinical trials.8,9 If HIV stigma is a barrier to HIV prevention and care services in impoverished and rural minority communities, it may also affect HIV clinical trial participation in these communities as well. Applying theory to understand the relationship between HIV stigma and HIV clinical trial participation in rural US communities will be useful in expanding our understanding of health disparities in HIV care access and utilization.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptN C Med J. Author manuscript; available in PMC 2011 February 11.Sengupta et al.PageIn recent years, theoretical frameworks have been posed to explore the complexity of HIV stigma and its impact in communities. The simplest theoretical framework breaks down HIV stigma into perceived stigma, experienced stigma, and internalized stigma.4 Perceived stigma is how PLWHA feel that they are being negatively treated by partners, family, friends, health care providers, and members of their community because of their HIV status. Experienced stigma is an act of discrimination towards PLWHA that includes denial of health care, education, or employment, or isolation from family me.
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