Improving Hospital-Based Quality of Care by Reducing HIV-Related Stigma: Evaluation Results from Vietnam

Abstract

Operations Research conducted at four hospitals in Vietnam sought to reduce HIV-related stigma and discrimination among hospital workers. The quasi-experimental study compared effects of focusing on 'fear-based' stigma (stemming from lack of knowledge) versus both fear-based and social stigma (stemming from moral judgments). Interventions included staff training (ranging from physicians to ward cleaners), hospital policy development, and supplies provision. At baseline (n = 795), reported stigma was substantial (e.g., about half of hospital workers indicated fear of casually touching PLHIV, and felt HIV was a punishment for bad behavior). By endline, stigma measures had improved significantly for both intervention groups (e.g., proportion reporting signs on beds indicating HIV status decreased from 51 to 24 % in Arm 1, and 31 to 7 % in Arm 2), with the combined intervention group showing greater effects. This study highlights successful strategies to reduce stigma, and thus, improve quality of care for PLHIV.

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

“…Fear of acquiring HIV while providing care for clients living with HIV improved significantly in intervention versus comparison facilities, as did associated stigmatizing avoidance behaviours such as double gloving. These findings mirror results of interventions in China [55] and Vietnam [56] that also included addressing fear of HIV transmission in the health facility as a key component of stigma‐reduction interventions. A further study in China underscores the importance of addressing fear directly and through a focus on standard precautions as a key strategy in reducing health facility stigma and discrimination [74].…”

“…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.…”

“…Additionally, more items in the composite attitude variables results in less change being expected because all of a respondent’s stigmatizing attitudes would have to be reduced to alter a single “none‐or‐any” composite. That changing (and measuring change in) stigmatizing attitudes is potentially more complicated than for other immediately actionable drivers of stigma is also highlighted by a study in Vietnam, where the arm of the study that received a focus on social stigma (attitudes) had a similar drop in stigmatizing attitudes to the arm that received only a focus on fear‐based stigma [56].…”

“…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].…”

HIV-Related Stigma Among Healthcare Providers in Different Healthcare Settings: A Cross-Sectional Study in Kerman, Iran

“…6 Interventions that reduce worry related to providing services to PLHIV and fear-based stigma through training on basic knowledge of HIV and universal precautions have been proven effective in reducing stigma and could be introduced in Iran to help improve the quality of care provided to PLHIV. 29 Working experience with PLHIV, passing educational courses related to HIV and other blood-borne infections, and fewer years of work experience were associated with lower HIV-related stigma. Experience of working with PLHIV could reduce stigma and more frequent contact with PLHIV infected patients would lead to less stigmatizing attitudes.…”