AIDS-related stigmatisation in the healthcare setting: a study of primary healthcare centres that provide services for prevention of mother-to-child transmission of HIV in Lagos, Nigeria

Abstract

ObjectiveTo assess AIDS stigmatising attitudes and behaviours by prevention of mother-to-child transmission (PMTCT) service providers in primary healthcare centres in Lagos, Nigeria.DesignCross-sectional survey.SettingThirty-eight primary healthcare centres in Lagos, Nigeria.ParticipantsOne hundred and sixty-one PMTCT service providers.Outcome measuresPMTCT service providers’ discriminatory behaviours, opinions and stigmatising attitudes towards persons living with HIV/AIDS (PLWHAs), and nature of the work environment (HIV/AIDS-related policies and infection-control guidelines/supplies).ResultsReported AIDS-related stigmatisation was low: few respondents (4%) reported hearing coworkers talk badly about PLWHAs or observed provision of poor-quality care to PLWHAs (15%). Health workers were not worried about secondary AIDS stigmatisation due to their occupation (86%). Opinions about PLWHAs were generally supportive; providers strongly agreed that women living with HIV should be allowed to have babies if they wished (94%). PMTCT service providers knew that consent was needed prior to HIV testing (86%) and noted that they would get in trouble at work if they discriminated against PLWHAs (83%). A minority reported discriminatory attitudes and behaviours; 39% reported wearing double gloves and 41% used other special infection-control measures when providing services to PLWHAs. Discriminatory behaviours were correlated with negative opinions about PLWHAs (r=0.21, p<0.01), fear of HIV infection (r=0.16, p<0.05) and professional resistance (r=0.32, p<0.001). Those who underwent HIV training had less fear of contagion.ConclusionsThis study documented generally low levels of reported AIDS-related stigmatisation by PMTCT service providers in primary healthcare centres in Lagos. Policies that reduce stigmatisation against PLWHA in the healthcare setting should be supported by the provision of basic resources for infection control. This may reassure healthcare workers of their safety, thus reducing their fear of contagion and professional resistance to care for individuals who are perceived to be at high risk of HIV.

‘Making the most of our situation’: a qualitative study reporting health providers’ perspectives on the challenges of implementing the prevention of mother-to-child transmission of HIV services in Lagos, Nigeria

“…A recent study suggests that training of health providers can reduce fear of infection and therefore make them less likely to engage in discriminatory healthcare practices such as double gloving. 17 As suggested by participants, community education, and the involvement of male partners especially in couples counselling may be effective. It is important to recognise that influences on AIDS-related stigmatisation and discrimination are rooted in the structure of communities and societies.…”

“…This study was embedded within a larger quantitative study, which methodology had previously been published. 17 Using a geopolitical map, we purposively selected central and western districts of the state for the study. These districts were chosen because they covered the largest areas of Lagos, including areas with populations with income levels that are most representative of the state.…”

“…Following standard methods for FGDs, 20 a topic guide for the FGD sessions was drafted at the University of Arizona, informed by analysis of results of the larger quantitative study previously reported 17 and a review of related literature. 21 22 It was later finalised in Lagos following pretesting and discussions with local collaborators.…”

Paradox of HIV stigma in an integrated chronic disease care in rural South Africa: Viewpoints of service users and providers

“…Although not in the context of the ICDM model, health worker-related stigma of this nature has been reported in the provision of reproductive health care in Ilorin, Nigeria, largely due to misperceptions [ 43 ]. On the other hand, a study in Lagos, Nigeria showed that health workers were supportive of women living with HIV who wished to have babies [ 44 ]. In Ghana, a study showed that a higher sexual and reproductive health stigma score was linked with a history of pregnancy among adolescents [ 45 ].…”

Malaria and HIV Infection among Febrile Patients in a Large Area of Southwestern Nigeria

“…As far as HIV/AIDS is concerned, its transmission is largely associated with large population sizes and fluid movement of people in and out of the state. 19 A descriptive cross-sectional study was conducted among febrile patients who presented themselves for medical examination at Reddington Hospital, one of the many hospitals in Ikeja receiving malaria patients. To calculate our sample size, we used the prevalence of malaria and HIV coinfection (2.9%) previously reported in Ikeja, 20 and a precision (d) of 2%.…”