The role of people living with HIV as patient instructors – reducing stigma and improving interest around HIV care among medical students

Abstract

People living with HIV/AIDS (PHAs) are increasingly recognized as experts in HIV and their own health. We developed a simulated clinical encounter (SCE) in which medical students provided HIV pre- and post-test counselling and point-of-care HIV testing for PHAs as patient instructors (PHA-PIs) under clinical preceptor supervision. The study assessed the acceptability of this teaching tool with a focus on assessing impact on HIV-related stigma among medical students. University of Toronto pre-clerkship medical students participated in a series of SCEs facilitated by 16 PHA-PIs and 22 clinical preceptors. Pre- and post-SCE students completed the validated Health Care Provider HIV/AIDS Stigma Scale (HPASS). HPASS measures overall stigma, as well as three domains within HIV stigma: stereotyping, discrimination, and prejudice. Higher scores represented higher levels of stigma. An additional questionnaire measured comfort in providing HIV-related care. Mean scores and results of paired t-tests are presented. Post-SCE, students (n = 62) demonstrated decreased overall stigma (68.74 vs. 61.81, p < .001) as well as decreased stigma within each domain. Post-SCE, students (n = 67) reported increased comfort in providing HIV-related care (10.24 vs. 18.06, p < .001). Involving PHA-PIs reduced HIV-related stigma among medical students and increased comfort in providing HIV-related care.

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].…”

Faculty Attitudes About Caring for People Living With HIV/AIDS: A Comparative Study

“…In this regard, expert patient illness narratives have been reported to be an effective teaching method for nursing students (Feijoo-Cid, Moriña, Gómez-Ibáñez, & Leyva-Moral, 2017) to develop cultural sensitivity, respect, and trust in others (Davidson, 2005). Similarly, when PLHIV are included as simulated patients, HIV-related stigma decreases and comfort in providing care increases (Jaworsky et al, 2017). More favorable attitudes about caring for HIV-infected pregnant women among certified nurse practitioners compared with RNs (Farley et al, 2014).…”

Ressources pour lutter contre la stigmatisation liée à la sexualité, à la toxicomanie et aux infections transmissibles sexuellement et par le sang

“…Ceux-ci comprennent la gêne des fournisseurs de services à discuter de sexualité ou de toxicomanie, les normes sociales stipulant que les personnes touchées par une ITSS sont à blâmer en raison de leur participation à des activités jugées moralement répréhensibles, telles que la débauche sexuelle ou la consommation de drogues, de même que les politiques et procédures organisationnelles qui contribuent par inadvertance à la stigmatisation. Par exemple, dans les milieux de la santé et des services sociaux, les formulaires d'admission n'emploient pas toujours un libellé inclusif, il y a souvent des pénalités pour les rendez-vous manqués et le personnel manque parfois de formation sur les questions liées à la sécurisation culturelle (des pratiques conçues pour que le client ou le patient se sente à l'aise) et à la réduction de la stigmatisation (3,(9)(10)(11)(12)(13). De plus, la stigmatisation liée aux ITSS ne se produit pas de façon isolée; elle peut aggraver d'autres formes de stigmatisation et d'oppression, comme la stigmatisation associée à la consommation de drogues injectables, à la prostitution, au racisme, au sexisme et à l'homophobie (5), menant ainsi à plusieurs couches de stigmatisation à l'endroit des personnes qui ont plus d'une identité stigmatisée.…”