HIV stigma intervention in a low-HIV prevalence setting: a pilot study in an Egyptian healthcare facility

Abstract

This pilot study is the first to evaluate stigma-reduction intervention in a healthcare setting in Egypt and in the Middle East and North Africa region. It also contributes to knowledge on how to address stigma in low-HIV prevalence settings. A quasi-experimental study design was used to evaluate the effect of anti-HIV stigma intervention in one hospital in Egypt. A control hospital was selected and matched to the intervention hospital by type, size and location. The intervention focused on HIV-related stigma, infection control and medical ethics. Stigma was measured at baseline and at three months post-intervention. A standardized, 10-point scale was developed to measure stigmatizing attitudes and fear-based stigma among participants. Comparisons of overall and job-stratified stigma scores were made across the intervention and control hospitals, before and after the intervention, using two-sample t-test and multivariate regression analysis. Mean stigma scores did not reveal significant differences between the intervention and control hospitals at baseline. After intervention, the overall value-based and fear-based stigma scores were significantly lower in the intervention hospital compared to the control hospital (2.1 and 1.1 compared to 3.8 and 3.2, respectively; p < .001). Context-specific and culturally appropriate HIV stigma-reduction interventions in low-HIV prevalence settings can reduce fear-based and value-based stigma among physicians and nurses.

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

“…This includes a recognition of the importance of addressing stigma in health facilities [72], yet concerted efforts to tackle stigma at any scale within countries are lacking, apart from Thailand [73]. One reason for such inaction may be the small, but growing, body of evidence of effective intervention models for HIV‐stigma reduction, particularly in health facilities [46,49‐56]. This paper adds to that literature.…”

“…Yet despite this evidence and global recognition of the need to tackle stigma – especially in health facilities – there is little concrete evidence of concerted efforts by countries and donors to scale‐up stigma‐reduction interventions in health facilities within national HIV responses. This may be in part due to the still nascent body of evaluated intervention approaches to stigma‐reduction in health facilities [46,49‐56].…”

Ending discrimination in healthcare

“…A recent review found evidence of the impact of these types of human rights programmes (singly and combined) on HIV‐related outcomes for people living with HIV and key and vulnerable populations most at risk of HIV, ranging from decreased HIV risk behaviours to increased HIV testing to reduced incidence . The review examined research published between 2003 and 2015, but evidence of the positive impact of similar interventions both prior to and after these dates have also been published; for example, focusing on the training of health workers to reduce stigma and programmes promoting legal literacy and advocacy . Advocacy targeting discriminatory laws, policies and practices have also been shown to be effective to removing barriers to HIV services , while evidence of the effectiveness of sensitizing law enforcement is increasing .…”

The cascade of HIV care in Oman, 2015–2018: A population-based study from the Middle East

“…The low HIV diagnosis rate observed in many countries in the MENA region, including Oman, could be attributed to several factors. A major reason is the high levels of HIV-related stigma and discrimination, which preclude access to HIV services (Feyissa et al, 2019;Lohiniva et al, 2016). Moreover, user-friendly services targeting key populations are limited.…”