A new study released Dec. 1 by the Williams Institute found that 5 percent of dental offices in Los Angeles County have a blanket policy of refusing dental services to people living with HIV/AIDS (PLWHA).
The study also found that an additional 5% of dental providers would treat PLWHA differently than other patients in ways that could potentially violate anti-discrimination laws. Examples of such different treatment include only providing the most basic of services to PLWHA, such as a cleaning, or only treating them on certain days of the week or in an isolated room.
“Thirty years into the epidemic, HIV-positive patients continue to face discrimination when accessing dental care,” says study co-author Brad Sears, Roberta A. Conroy Scholar of Law and executive director of the Williams Institute. “While it is definitely encouraging that 90% of dentists in Los Angeles County do treat HIV-positive patients, it is likely that the rate of discrimination is higher in other parts of the country.”
The study used trained “testers,” researchers who called dental offices posing as potential new HIV-positive patients, to measure the level of HIV-discrimination. In total, 612 dental offices in Los Angeles County were contacted in 2007 and 2008. Calls to the offices were made in English and Spanish, and by callers who said they had private dental insurance as well as Denti-Cal, a dental benefit tied to California’s Medicaid program (that was largely de-funded in 2009).
The study also found that the rate of dentists having unlawful blanket policies of refusing service to PLWHA is lower than that of other health care providers that have been previously studied. Similar studies of health care providers in Los Angeles County conducted by Sears between 2003 and 2006 found that 55% of obstetricians, 46% of skilled nursing facilities, and 25% of plastic surgeons had such policies.
“The study suggests that consistent legal enforcement and education efforts, both during dental school and afterwards, have had a positive effect on dentists, and have thus created expanded access to care for PLWHA,” says Sears.
The most common reasons that the dentists gave for refusing to accept HIV-positive patient were that the dental office was not equipped to treat HIV-positive patients and that extra infection control precautions would be required.
“Dentists can treat HIV-positive patients safely and effectively,” says study co-author Fariba S. Younai, professor of clinical sciences and vice chair, division of oral biology and medicine, UCLA School of Dentistry. “The same standard infection control precautions should be used with all patients and every patient should be treated as if they had a blood borne disease. Thus, every dental office should be equipped to treat HIV-positive patients.”
Despite the overall lower rate of discrimination, the study found that levels of discrimination were twice as high for PLWHA who had Denti-Cal as opposed to private dental insurance. In addition, dentists who were older and who did not go to dental school in the United States were more likely to provide a discriminatory response.
Rates of discrimination were also higher in areas of Los Angeles County with higher rates of HIV-infection, and with more low-income people, people of color and women among the infected. Specifically, rates of discrimination were significantly higher in the San Gabriel Valley and South Public Health Service Planning Areas (SPAs), as compared to other parts of Los Angeles County.
“The findings indicate that training and education efforts over the past 20 years have had a positive effect. Many of the dental clinics tested responded with affirmations such as, ‘Of course we would accept you -we do not discriminate here.’ However, the data also suggest the need for more targeted education efforts to ensure equal access to dental services for all PLWHA,” says study co-author Tom Donohoe, Associate Professor of Family Medicine at UCLA’s David Geffen School of Medicine and Director, UCLA/Pacific AIDS Education and Training Center.
A national think tank based at UCLA Law, the Williams Institute researches sexual orientation law and public policy through independent research and scholarship. For more information, click here.
