Understanding and measuring AIDS-related stigma in health care settings: A developing country perspective

Abstract

AIDS-related stigma and discrimination remain pervasive problems in health care institutions worldwide. This paper reports on stigma-related baseline findings from a study in New Delhi, India to evaluate the impact of a stigma-reduction intervention in three large hospitals. Data were collected via in-depth interviews with hospital staff and HIV-infected patients, surveys with hospital workers (884 doctors, nurses and ward staff) and observations of hospital practices. Interview findings highlighted drivers and manifestations of stigma that are important to address, and that are likely to have wider relevance for other developing country health care settings. These clustered around attitudes towards hospital practices, such as informing family members of a patient's HIV status without his/her consent, burning the linen of HIV-infected patients, charging HIV-infected patients for the cost of infection control supplies, and the use of gloves only with HIV-infected patients. These findings informed the development and evaluation of a culturally appropriate index to measure stigma in this setting. Baseline findings indicate that the stigma index is sufficiently reliable (alpha = 0.74). Higher scores on the stigma index--which focuses on attitudes towards HIV-infected persons--were associated with incorrect knowledge about HIV transmission and discriminatory practices. Stigma scores also varied by type of health care providers--physicians reported the least stigmatising attitudes as compared to nursing and ward staff in the hospitals. The study findings highlight issues particular to the health care sector in limited-resource settings. To be successful, stigma-reduction interventions, and the measures used to assess changes, need to take into account the sociocultural and economic context within which stigma occurs.

Perceptions of Stigma and Discrimination in Health Care Settings Towards Sub-Saharan African Migrant Women Living With Hiv/Aids in Belgium: A Qualitative Study

“…Generally, participants acknowledged that the magnitude of stigma and/or discrimination has greatly decreased compared with previous years. As in previous studies (Surlis & Hyde, 2001;Letamo, 2005;Reis et al, 2005;Mahendra et al, 2007;Feyissa et al, 2012;Ekstrand et al, 2013), this study found some variation in the causes of stigma and discrimination in health care settings. It confirms that existing stigma and discrimination in society, transmission-related fear and institutional policies on HIV management, as well as lack of proper knowledge of HIV amongst health care workers not directly involved in the treatment of SSA migrant women with HIV, drive and endorse stigma feelings and discriminatory attitudes.…”

A systematic review of HIV/AIDS-related stigma and discrimination in India: Current understanding and future needs

“…Groups vulnerable to HIV are commonly associated with HIV infection in India which predisposes them to discrimination. A little less than half of all health staff (43%) in a base line survey (Mahendra et al, 2007) for instance, agreed with the statement, 'sex workers are the only women to worry about getting HIV' implying that sex workers are the only women who are vulnerable to HIV because of their risk behaviour.…”

“…HIV status disclosure forms an important theme in many stigma studies. Involuntary disclosure of a person's HIV status in the health setting through health staff is reported to be the beginning of the stigmatisation experience for most positive people in India (Bharat et al, 2001;Elamon, 2005;Paxton et al, 2005;Mahendra, Gilborn, Bharat, Mudoi, Gupta, George et al, 2007). See Box 1.…”

“…Health care settings are reported to be the most significant contexts for stigma and discrimination in India (Bharat et al, 2001;Thomas et al, 2005;Mahendra et al, 2007;Pisal, Sutar, Sastry, Kapadia-Kundu, Joshi, Leslie et al, 2007;Elamon, 2005;Paxton et al, 2005). Across staff levels attitudes towards positive patients are unfavourable and the basis for their discriminatory acts.…”

Attitude of health care workers to patients and colleagues infected with human immunodeficiency virus

“…The health sector has been identified as one of the areas in which discrimination occurs (Mahendra, et al, 2007). Studies have documented negative attitudes to PLWHA in health care settings in Nigeria and elsewhere (Adelekan et al, 1995;Fido & Al Kamezi, 2002;Hentgen, Jaureguiberry, Ramiliarisoa, Andrianantoandro & Belec, 2002;Quach, Mayer, McGarvey, Lurie & Do, 2005;Reis et al, 2005).…”