Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions

Abstract

IntroductionHIV stigma inflicts hardship and suffering on people living with HIV (PLHIV) and interferes with both prevention and treatment efforts. Health professionals are often named by PLHIV as an important source of stigma. This study was designed to examine rates and drivers of stigma and discrimination among doctors, nurses and ward staff in different urban healthcare settings in high HIV prevalence states in India.MethodsThis cross-sectional study enrolled 305 doctors, 369 nurses and 346 ward staff in both governmental and non-governmental healthcare settings in Mumbai and Bengaluru, India. The approximately one-hour long interviews focused on knowledge related to HIV transmission, personal and professional experiences with PLHIV, instrumental and symbolic stigma, endorsement of coercive policies, and intent to discriminate in professional and personal situations that involve high and low risk of fluid exposure.ResultsHigh levels of stigma were reported by all groups. This included a willingness to prohibit female PLHIV from having children (55 to 80%), endorsement of mandatory testing for female sex workers (94 to 97%) and surgery patients (90 to 99%), and stating that people who acquired HIV through sex or drugs “got what they deserved” (50 to 83%). In addition, 89% of doctors, 88% of nurses and 73% of ward staff stated that they would discriminate against PLHIV in professional situations that involved high likelihood of fluid exposure, and 57% doctors, 40% nurses and 71% ward staff stated that they would do so in low-risk situations as well. Significant and modifiable drivers of stigma and discrimination included having less frequent contact with PLHIV, and a greater number of transmission misconceptions, blame, instrumental and symbolic stigma. Participants in all three groups reported high rates of endorsement of coercive measures and intent to discriminate against PLHIV. Stigma and discrimination were associated with multiple modifiable drivers, which are consistent with previous research, and which need to be targeted in future interventions.ConclusionsStigma reduction intervention programmes targeting healthcare providers in urban India need to address fear of transmission, improve universal precaution skills, and involve PLHIV at all stages of the intervention to reduce symbolic stigma and ensure that relevant patient interaction skills are taught.

Stigmatization and the Predictors of Reported Discrimination among HIV Positive Patients Receiving Care in Hospitals in Imo State, Nigeria

“…The perpetuation of stigmatizing attitudes and discrimination by healthcare workers has been widely reported, ranging from issues of confidentiality, verbal harassment to denial of treatment [4, [27][28][29]. As a result, it is not unexpected that respondents in the present study who came in contact with the healthcare system and were advised by health personnel to do a HIV test were significantly more likely to have reported discrimination than those who advised themselves.…”

Study on Defense Mechanisms to Cope With Stress Due to Stigma Among People Living With HIV/AIDS Reported in Eastern India: A Single Center Experience

“…20 Marfatia et al 20 showed that 25% HIVinfected individuals in India had been refused medical care due to strong evidence of stigma at workplace, and 74% of PLWHA did not disclose disease status for fear of discrimination and community retaliation. Surprisingly, stigma and discrimination have also been found to be very common in health setups as pointed by Ekstrand et al 21 Given such a situation, it becomes imperative in many ways, for PLWHA to adopt defense strategies to cope with an inherent stress associated with stigmatization. Freud in his psychoanalytical theory defined defense mechanisms as unconscious psychological strategies brought into play by various entities to cope with reality and to maintain self-image.…”

The role of emotions in the reduction of HIV/AIDS stigma among physicians in training

“…HIV/AIDS stigma among health professionals is common and can be a barrier to effective access to treatment (Ekstrand, Ramakrishna, Bharat, & Heylen, 2013; Varas-Díaz, Malavé-Rivera, & Cintrón-Bou, 2008; Varas-Diaz & Neilands, 2009; Varas-Diaz, Neilands, Malave Rivera, & Betancourt, 2010). Although research has been nimble to respond in developing strategies to document HIV/AIDS stigma among health professionals, the development of effective interventions to reduce it has lagged behind.…”