HIV Discrimination in Dental Care

Executive Summary

This study used trained testers to measure the level of HIV discrimination by dentists in Los Angeles County. In total, 612 dentists’ offices were contacted in 2007 and 2008. We find that levels of HIV discrimination are lower in dental care than other health care services in Los Angeles County. However, levels of discrimination are twice as high for people living with HIV/AIDS (PLWHA) who had Denti-Cal, and three times higher for those living in the San Gabriel Valley and South SPAs. Discrimination was also higher among older dentists and dentists who did not go to dental school in the United States. The findings suggest the need for more targeted education efforts to ensure equal access to dental services for all PLWHA.

Key Findings

• Five percent of dental offices contacted (29) had an unlawful blanket policy of refusing dental services to any PLWHA.
• An additional 5% of dental providers (32) indicated they would treat PLWHA differently than other patients in ways that could potentially violate state and federal anti-discrimination laws.
• Factors influencing the rates of discrimination were the caller’s type of dental insurance, the geographic location of the dental practices, and when and where the dentist graduated from dental school.
• Ninety percent of all dental offices contacted in Los Angeles County (551) responded that they would treat PLWHA.

Specific Findings

• Rates of discrimination were twice as high when testers indicated that they had Denti-Cal (a public benefit for poorer patients that was largely discontinued by California in 2009) as opposed to private dental insurance.

• Rates of discrimination varied significantly in different parts of Los Angeles County, and rates were higher in areas of the county with higher rates of HIV-infection, and with more low-income people, people of color and women among the infected. The Los Angeles County Department of Public Health has divided Los Angeles into eight geographical regions, called Service Planning Areas (SPAs). When the blanket policies of refusal of service to all PLWHA are combined with differences in treatment that could be unlawful discrimination, the frequency of such responses was significantly higher for providers in the South (20%) and San Gabriel Valley (17%) SPAs.
• Eleven percent of providers in the San Gabriel Valley SPA indicated that they would not accept any PLWHA. This SPA accounted for one-third of all the blanket policies of refusal of service identified in the study.

• While only 68% of the dentists in the study overall graduated prior to 1988, almost 90% of dentists whose responses were classified as discriminatory or potentially discriminatory graduated before 1988. In fact, only two dentists who graduated from dental school after 1988 gave a response classified as “no” or “different treatment.”
• While only one-fourth of the dentists in the study graduated from a dental school outside of the United States, almost 40% of the “no” and “different treatment” responses were given by dentists who went to dental schools in other countries.
• The most common reasons for refusing service to all PLWHA were as follows:
  • The office was not equipped to treat PLWHA (38%).
  • Extra infection control precautions would be required (7%).
  • The office had never treated an HIV-positive patient before (7%).
• Over half of the dentists who refused services to all PLWHA (52%) told the caller they should seek services from another provider, a clinic, or a hospital.
• The rate of dentists having unlawful blanket policies of refusing service to all PLWHA is lower than that of other health care providers that have been studied. Similar studies of health care providers in Los Angeles County conducted between 2003 and 2006, found that 55% of obstetricians, 46% of skilled nursing facilities, and 26% of plastic surgeons had such policies.

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