# Combating HIV Stigma in Healthcare Settings: A Standardized Patient Approach

> **NIH NIH R01** · UNIVERSITY OF MINNESOTA · 2024 · $682,470

## Abstract

40 years into the pandemic, stigma remains the most challenging barrier for HIV prevention. A quarter of
people living with HIV remain untested, depriving them of opportunities to enter the HIV prevention continuum
and access evidence based prevention tools. Testing is particularly low in gay and bisexual men who have sex
with men (MSM) who face additional discrimination on account of their same sex behaviors. Stigma can be
internalized or anticipated but it is most pernicious when it is enacted in healthcare settings, as this directly
bars care access while also discouraging future care seeking. Enacted healthcare stigma is notoriously difficult
to measure, as few providers willingly report discriminatory behavior and patients lack the medical knowledge
to assess the appropriateness of care. Our solution is to conduct unannounced standardized patient (SP) visits
to measure and address enacted healthcare stigma. SPs are actors hired from the local community and trained
to present standardized, unannounced disease cases in area clinics for the purposes of evaluation and
feedback. Their ability to objectively document provider behaviors through unannounced visits presents an
elegant solution to the common tendency of providers to alter behaviors under observation. By randomly
varying the sexual orientation and HIV status of presented cases, our technique obtains discrete measures of
HIV, sexual, and intersectional stigma. Results of an initial round of SP visits are shared with advisory boards
of providers and MSM to solicit their views on stigma drivers which inform a tailored stigma reduction training
for study providers which is then evaluated in a second round of visits. Our team has conducted an NIH-funded
pilot randomized control trial (RCT) in southern China that demonstrated high feasibility and acceptability of the
SP approach for measuring and reducing stigma (R34MH121251). This R01 application follows on the success
of the R34 to propose a fully powered cluster RCT using tools, lessons, and experience gained form our pilot.
This trial will newly include rural clinics to expand generalizability and will also explore future implementation
potential of our intervention with regional policy makers. Our interdisciplinary team combines expertise in HIV
prevention, stigma, LGBT health, standardized patient research, and medical education to investigate the
following aims: 1) Conduct a baseline round of SP visits to inform the design of a SP-informed stigma reduction
intervention with support from MSM and provider community advisory boards; 2) implement the intervention in
treatment arm clinics and evaluate its impact on enacted stigma and clinic-level HIV testing volume and 3)
conduct qualitative interviews with stakeholders (providers, MSM, health officials) to help inform the design of a
Implementation Blueprint to guide potential future adopters in assessing its suitability and their team readiness
to implement a SP-informed stigma intervent...

## Key facts

- **NIH application ID:** 10923386
- **Project number:** 1R01MH136900-01
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** M Kumi Smith
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $682,470
- **Award type:** 1
- **Project period:** 2024-09-16 → 2029-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10923386

## Citation

> US National Institutes of Health, RePORTER application 10923386, Combating HIV Stigma in Healthcare Settings: A Standardized Patient Approach (1R01MH136900-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10923386. Licensed CC0.

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