HIV Stigma and Discrimination: Perspectives and Personal Experiences of Healthcare Providers in Yogyakarta and Belu, Indonesia

Abstract

Stigma and discrimination are major challenges facing People Living with HIV/AIDS (PLWHA) globally due to their HIV status. As part of a larger qualitative study in Yogyakarta and Belu, Indonesia, using in-depth interviews with 92 PLWHA (52 women, 40 men) and 20 healthcare providers, this paper describes perspectives and personal experiences of the 20 healthcare providers, relating to HIV stigma and discrimination toward PLWHA in both study settings. The healthcare providers were recruited from healthcare facilities providing HIV-related healthcare services, using a snowball sampling technique. A qualitative framework analysis was used to guide data analysis. Health stigma and discrimination framework guided the conceptualisation and discussion of the findings. The findings presented the views and perspectives of healthcare providers that HIV stigma and discrimination toward PLWHA still occurred within families, communities and healthcare settings. These were reflected in negative labelling, separation of personal belongings, avoidance, denial of treatment and rejection of PLWHA by healthcare providers, family and community members. Some healthcare providers reported that they had personally stigmatised and discriminated against PLWHA. A lack of knowledge about HIV, fear of contracting HIV, personal values, religious thoughts and sociocultural values and norms, were reported as drivers or facilitators behind this HIV-related stigma and discrimination. The findings indicate the importance of continued HIV/AIDS education for families, community members and healthcare providers, to raise awareness and to ensure that healthy and professional support systems are in place for PLWHA. The findings indicate the need to enhance improvement within the healthcare or HIV care system to adequately address the needs of PLWHA, which may facilitate their early initiation of HIV treatment and better treatment adherence and retention to increase Cluster of Differentiation 4 (CD4) count and suppress viral load. Future studies are also needed to explore the role that government and non-government institutions can play in improving health service delivery for people newly diagnosed with HIV and those living with HIV/AIDS.

Stigma and Discrimination towards People Living with HIV in the Context of Families, Communities, and Healthcare Settings: A Qualitative Study in Indonesia

“…In line with the concepts in the HIV stigma framework and the reports of previous studies in other settings [3,17,[19][20][21][22]52], the current study confirms that HIV stigma and discrimination also experienced by participants within communities where they lived and worked. These manifested in a range of unfair treatments by other community members, such as refusal of eating food they have touched, avoidance of shaking hands or sitting next to them and keeping a distance from them due to the fear of contracting HIV which seemed to be supported by a lack knowledge of the means of HIV transmission [13,14,[25][26][27]52]. This study also provides new evidence that discriminatory and stigmatizing attitudes and behaviors of neighbors and friends or community members towards the participants were influenced by negative social and moral perceptions or judgements about HIV and PLHIV, which seemed to be rooted in their religious thoughts about extra-marital sex and sex with multiple sex partners as sins and HIV infection as a curse for PLHIV.…”

Determinants Model in Reducing HIV-Related Stigma in Health care Workers: A Systematic Review

“…The use of such thinking as a parameter to assess the behavior of PLWHA causes the reluctance of health-care providers to serve, interact, and feel disgusted with HIV patients [21]. This supports the findings of a previous study which reported that the inclusion of personal religious beliefs in the provision of health to PLWHA led to clashes between personal religious values and professional expectations [20].…”

“…In the learning process, all nurses and midwives are equipped with knowledge and skills according to professional competencies/ standards, especially in providing services to PLWHA. However, the reality is that after they graduate and get a diploma, they are not automatically able to enter the ministry [18], [20].…”

“…The sociocultural values possessed by health workers are the driving force for discriminatory and stigmatizing attitudes and behavior toward PLWHA. Values of fidelity in marriage and not accepting cheating behavior in PLWHA who are married because it is considered painful for their partner are some examples of personal values held by some participants in research [20] that supports their discriminatory behavior toward PLWHA. The personal values held by these health workers also seem to lead to a personal assessment that PLWHA deserves infection as a consequence of their own behavior.…”

Cross-Cultural Adaptation and Psychometric Assessment of an Arabic Version of the Health Care Provider HIV/AIDS Stigma Scale

“…[12][13][14] Reasons for HCPs' stigmatization and discrimination against PLHIV include insufficient knowledge of HIV, perceived occupational risk of infection, and fear of death. 15 Other factors that might play a role in HCPs' attitudes include unfamiliarity with universal precautions and lack of adequate protective equipment. 7,13,16 Providers' discrimination against PLHIV has also been attributed to the behaviors believed to have led to infection, such as homosexuality, having multiple sexual partners, and injecting drugs.…”