Combating HIV stigma in health care settings: what works? (original) (raw)
Related papers
Journal of the International AIDS Society
Introduction: There is robust evidence that stigma negatively impacts both people living with HIV and those who might benefit from HIV prevention interventions. Within healthcare settings, research on HIV stigma has focused on intra-personal processes (i.e. knowledge or internalization of community-level stigma that might limit clients' engagement in care) or interpersonal processes (i.e. stigmatized interactions with service providers). Intersectional approaches to stigma call us to examine the ways that intersecting systems of power and oppression produce stigma not only at the individual and interpersonal levels, but also within healthcare service delivery systems. This commentary argues for the importance of analysing and disrupting the way in which stigma may be (intentionally or unintentionally) enacted and sustained within HIV service implementation, that is the policies, protocols and strategies used to deliver HIV prevention and care. We contend that as HIV researchers and practitioners, we have failed to fully specify or examine the mechanisms through which HIV service implementation itself may reinforce stigma and perpetuate inequity. Discussion: We apply Link and Phelan's five stigma components (labelling, stereotyping, separation, status loss and discrimination) as a framework for analysing the way in which stigma manifests in existing service implementation and for evaluating new HIV implementation strategies. We present three examples of common HIV service implementation strategies and consider their potential to activate stigma components, with particular attention to how our understanding of these dynamics can be enhanced and expanded by the application of intersectional perspectives. We then provide a set of sample questions that can be used to develop and test novel implementation strategies designed to mitigate against HIV-specific and intersectional stigma. Conclusions: This commentary is a theory-informed call to action for the assessment of existing HIV service implementation, for the development of new stigma-reducing implementation strategies and for the explicit inclusion of stigma reduction as a core outcome in implementation research and evaluation. We argue that these strategies have the potential to make critical contributions to our ability to address many system-level form stigmas that undermine health and wellbeing for people living with HIV and those in need of HIV prevention services.
HIV and stigma in the healthcare setting
Oral Diseases, 2020
Despite global improvements in the health outcomes and life expectancy of people living with HIV (PLHIV), HIV stigma exists within healthcare settings. PLHIV experience discrimination in healthcare settings including dental settings. HIV stigma may present itself in a number of ways that have negative impacts for the oral and general health of PLHIV. Such practices may include the use of personal protective equipment in excess of what is considered routine for patients who are not know to be living with HIV, delaying the provision of care or unnecessary referral of PLHIV to specialist services in order to access care. The workshop entitled "HIV and Stigma in the Healthcare Setting" provided an overview of the concept of HIV stigma and explored the ways it affects PLHIV within healthcare and dental settings. The latter part of the workshop explored the impact of HIV stigma faced by sexual and gender minorities and the disproportionate burden it places on groups that face additional disadvantages when attempting to access health care. The final part of the workshop concluded with a review of institutional and community interventions that are working to reduce HIV stigma. Following on from the presentations, the delegates were asked to consider ways in which these strategies might be adapted to the dental workforce and this has been illustrated in the discussion section of this paper. This paper has been written as a collaborative effort between dental researchers, social scientists and advocates for PLHIV.
2013
Background: The HIV and AIDS epidemic has created a human resource crisis that "has replaced financial issues as the most serious obstacle to implementing national treatment plans" (WHO 2006a: 20). To retain the existing health workforce, international guidelines promote priority access to health services for health workers (HWs) through occupationally-based HIV counseling and testing (HCT) services. Such services have been implemented in South Africa (RSA), however recent evidence suggests their uptake is low. Objective: To identify barriers and facilitators to uptake of HCT services by HWs in three hospitals in Free State province, RSA. Methods: This mixed-methods study analyzed a portion of a self-administered survey and focus groups interviews (FGIs) to explore participants' attitudes and behaviours related to HIV in the workplace, why HIV services may be underutilized and participants' recommendations to improve the service. Results: In total, 978 HWs participated in the survey and 38 participated in the FGIs. Among survey respondents, 38.9% indicated a fear that confidentiality will not be maintained as the reason for not using OHS-based HIV services. 38.5% HWs perceive there is HIV stigma in the workplace. Six themes were identified from the FGIs, including location for testing, privacy, confidentiality, gossip, stigma and facilitators. FG participants perceived doctors' and nurses' experience with HIV in the workplace differs from other HWs, supported by multivariate analyses indicating patient-care HWs (PCHWs) have higher odds of perceiving confidentiality is not maintained in the OHS (adjusted ORs = 2.3; 95% CI 1.8-3.2) and perceiving HIV stigma in the workplace (adjusted OR = 2.4; 95% CI 1.8-3.2) when compared to non-PCHWs. FG participants iii also identified the need for in-service training on a range of topics related to HIV and expressed a desire to form HIV support groups to address negative attitudes toward HIV/AIDS in the workplace. Conclusions: Fear of breaches in confidentiality and HIV stigma were identified as the primary barriers to uptake of occupationally-based HCT by HWs. Overcoming these barriers require educating HWs on policies and guidelines that govern HIV in the workplace, implement measures to ensure confidentiality is maintained and addressing HIV stigma through stigma reduction interventions.
Accessing health services while living with HIV: intersections of stigma
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2009
AIDS stigma has serious consequences. This study explored those practices within health-care organizations that persons with HIV perceive as stigmatizing. It used an exploratory, descriptive design using a participatory action research approach. Interviews and focus groups were conducted with 16 Aboriginal and 17 non-Aboriginal persons living with HIV as well as with 27 health-care providers. The AIDS stigma perceived by many participants often intersected with other forms of stigma, related to behaviour, culture, gender, sexual orientation, or social class. In addition, policies at the organizational level contributed to AIDS stigma and at times intersected with stigma at the individual level. Participants' experiences of stigma and discrimination were shaped by the organizational policies (universal precautions, models of care) and design (physical layout) under which care was provided. Several paradoxes associated with secrecy, health-care settings, and the layering of stigma...
This case describes the research methods and procedures that were used for the development of guideline recommendations to reduce HIV-related stigma and discrimination. The major challenge in the project was that there were no previous evidence-based guidelines, nor systematic reviews reported based on the framework suggested by Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). This makes the formulation of recommendations challenging. In addition, taking global evidence into a local context requires analysis of contextual and local factors, such as feasibility and acceptability.
Journal of the International AIDS Society, 2013
Introduction: Within healthcare settings, HIV-related stigma is a recognized barrier to access of HIV prevention and treatment services and yet, few efforts have been made to scale-up stigma reduction programs in service delivery. This is in part due to the lack of a brief, simple, standardized tool for measuring stigma among all levels of health facility staff that works across diverse HIV prevalence, language and healthcare settings. In response, an international consortium led by the Health Policy Project, has developed and field tested a stigma measurement tool for use with health facility staff. Methods: Experts participated in a content-development workshop to review an item pool of existing measures, identify gaps and prioritize questions. The resulting questionnaire was field tested in six diverse sites (China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis). Respondents included clinical and non-clinical staff. Questionnaires were self-or interviewer-administered. Analysis of item performance across sites examined both psychometric properties and contextual issues. Results: The key outcome of the process was a substantially reduced questionnaire. Eighteen core questions measure three programmatically actionable drivers of stigma within health facilities (worry about HIV transmission, attitudes towards people living with HIV (PLHIV), and health facility environment, including policies), and enacted stigma. The questionnaire also includes one short scale for attitudes towards PLHIV (5-item scale, a 0 0.78). Conclusions: Stigma-reduction programmes in healthcare facilities are urgently needed to improve the quality of care provided, uphold the human right to healthcare, increase access to health services, and maximize investments in HIV prevention and treatment. This brief, standardized tool will facilitate inclusion of stigma measurement in research studies and in routine facility data collection, allowing for the monitoring of stigma within healthcare facilities and evaluation of stigma-reduction programmes. There is potential for wide use of the tool either as a stand-alone survey or integrated within other studies of health facility staff.
Journal of the International Association of Providers of AIDS Care, 2022
The study focused on the representations, processes and effects of HIV stigma for healthcare workers living with HIV within health facilities in Zambia. A descriptive study design was deployed. A total of 56 health workers and four service user participants responded to a structured questionnaire (n = 50) or took part in key informant interviews (n = 10) in five high HIV-prevalence provinces. Most participants did not disclose if they were living with HIV, except for four participants who responded to the questionnaire and were selected for being open about living with HIV. Semi-structured interviews were carried out with health workers in key government health facility positions. The questions were standardized and used a Likert scale. Descriptive statistical and thematic analyses were applied to the data. Results show that antiretroviral treatment (ART) has an impact on stigma reduction. Almost half the participants agreed that treatment is reducing levels of HIV stigma. However, fears of exposure of HIV status and labelling and judgemental attitudes persist. No comprehensive stigma reduction policies and guidelines in healthcare facilities were mentioned. Informal flexible systems to deliver HIV services were in place for health workers living with HIV, illustrating how stigma can be quietly navigated. Lack of confidentiality in healthcare facilities plays a role in fuelling disclosure issues and hampering access to testing and treatment. Stigma reduction training needs standardization. Further, codes of conduct for 'stigma-free healthcare settings' should be developed.
Stigma towards clients in HIV/AIDS care settings
Journal of Nursing Education and Practice, 2020
Stigmatizing behaviors engaged by care providers in clinical settings represent a significant barrier to care seeking on the part of persons living with HIV. The majority of studies addressing stigma by healthcare workers has been reported in the developing world. The current study sought to determine the presence of stigmatizing thoughts and behaviors in Ryan White Care Act funded clinics across the United States. The study used a quantitative descriptive design, and included all such sights in the US and its territories. The results indicated that paraprofessional personnel were more likely to engage in thoughts and behaviors that reflect stigma. This finding is significant since these individuals are the first people who patients contact when seeking care, establishing a significant barrier to retention in care. The study reflects a need to engage education and training designed to minimize these behaviors in paraprofessionals.