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May 11, 2007
DO-GOOD DOC
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Cunningham doing outreach in Harlem |
It's not everyday that researchers release studies about discrimination in the health care system against homeless people of color with HIV in New York City — or that a mainstream news agency like Reuters reports on it.
The woman behind the headline-grabbing study, analyzed in an article in a recent issue of Public Health Reports, is a young African American assistant professor of medicine at Montefiore Medical Center/Albert Einstein College of Medicine named Chinazo Cunningham. "There aren't that many people who do this kind of work, and that's part of the draw for me. Because of my background, I can look at things a bit differently and ask different questions," Cunningham says.
The three-year study, which was funded through the CDC with money from the embattled Minority AIDS Initiative, surveyed 523 HIV-positive folks living in Manhattan and Bronx SROs. They were overwhelmingly male and overwhelmingly black or Latino. A whopping 40 percent or participants said they had experienced discrimination in the health care system. 60 percent of that group attributed the discrimination to their HIV status; 50 percent cited their drug use; 35 percent said race or ethnicity played a role; 35 percent said it was because they were homeless (nearly half of the respondents considered themselves to be homeless).
CUNY assistant professor Nancy Sohler, the lead author on the Public Health Reports article and a coinvestigator on the study, notes that the study's interviewers used handheld devices to conduct their survey and that participants were asked to enter their answers themselves, which most did. "Other researchers thought we'd have trouble but people did just fine," Sohler says, adding, "If we make sure our interviewers are respectful and the questions are truly meant to help, most people wanted to help out." 87 percent of people they approached agreed to participate.
Little trust, little care
The real goal of the study was not simply to gather numbers about discrimination but to find out if there was a link between discrimination and the likelihood of homeless and low-income people with HIV distrusting the health care system and avoiding seeking treatment. Participants' ratings of the health care system and providers were "strongly and consistently negatively associated with our summary measure of perceived discrimination," the study says.
The study made special note of the fact that, in accordance with past research, drug users were in particular danger of neglect, raising concerns that they "may be inappropriately denied life-prolonging treatments."
Cunningham, who regularly treats HIV-positive patients from the South Bronx, says that reports of discrimination — defined as hostility or lack of respect, refusal of services or lack of attention — bear out her experience, "from people talking dismissively about this population, or paternalistically, or trying to get them out of the hospital. A lot of people can't imagine what a homeless person's life is like and the challenges they face. Bringing this kind of research to the forefront will help people learn how to give better care." Cunningham has already been involved in writing a curriculum for AIDS Education Training Centers, where medical professionals learn about treating patients with HIV.
Both Cunningham and Sohler hope their research will lead to better bridges between poor people with HIV and the medical system. They're putting together a grant to explore using "peer navigators" who could go door-to-door in places like SROs to help do exactly that. And for now, Cunningham says, "we're just happy people are paying attention to our work."