Addressing Stigma and Privacy Through Telemedicine: Qualitative Findings on Enhancing HIV Care Engagement Among Racial and Ethnic Minority Groups.

We conducted a demonstration project of telemedicine HIV care services at the University of Florida (UF) College of Medicine, Jacksonville. Our sample focused on members of racial and ethnic minority groups living in an urban setting. As part of the project's evaluation, we conducted 13 focus groups. Focus groups assessed patient, staff, and provider experiences with facilitating or hindering factors to engaging in telemedicine. We also explored the decision-making processes among people with HIV (PWH) to engage or not in telemedicine. The 46 focus group participants included 21 PWH: 12 PWH who accepted and nine who declined participation in telemedicine. The remaining 25 focus group participants were comprised of medical, clinical support, and community-based organization staff who supported the demonstration project. An unexpected finding that emerged in the focus group narratives detailed that some PWH who accepted telemedicine visits appreciated that telemedicine minimized the stigma they have experienced during in-person healthcare encounters. Among PWH who declined a telemedicine visit, they felt the extension of service into their personal world invaded their privacy, created routes for stigma should their HIV status be disclosed outside the healthcare setting, and raised concerns about confidentiality in virtual settings. Like the PWH, the professionals were mixed in their opinions in that some felt telemedicine facilitated care while others raised concerns. Findings point to the importance of allowing PWH to select the format (in-person or via telemedicine) in which their HIV care is rendered and highlight the importance of intervening to decrease healthcare facility-based stigma.