Measuring HIV-related stigma among healthcare providers: a systematic review

In the United States, HIV-related stigma in the healthcare setting is known to affect the utilization of prevention and treatment services. Multiple HIV/AIDS stigma scales have been developed to assess the attitudes and behaviors of the general population in the U.S. towards people living with HIV/AIDS, but fewer scales have been developed to assess HIV-related stigma among healthcare providers. This systematic review aimed to identify and evaluate the measurement tools used to assess HIV stigma among healthcare providers in the U.S. The five studies selected quantitatively assessed the perceived HIV stigma among healthcare providers from the patient or provider perspective, included HIV stigma as a primary outcome, and were conducted in the U.S. These five studies used adapted forms of four HIV stigma scales. No standardized measure was identified. Assessment of HIV stigma among providers is valuable to better understand how this phenomenon may impact health outcomes and to inform interventions aiming to improve healthcare delivery and utilization.     

Religious beliefs and HIV-related stigma: Considerations for healthcare providers

Globally, the stigmatic behavior toward people living with HIV(PLHIV) has marginalized them. The aim of this study was to determine the effects of religious beliefs and demographic variables on healthcare providers’ stigmatic perspectives towards PLHIV. A total of 575 healthcare providers in Shiraz completed a structured questionnaire. Data were analyzed using the STATA package. The findings indicated a significant association between the stigmatic perspective of healthcare providers and their religious beliefs (p?p?=?0.001). In addition, social class and marital status were predictors, but they had a significant association with stigmatic view (p?>?0.05).

To reduce stigma and discrimination, training healthcare providers is inevitable. Thus, a program with a focus on the rights of PLHIV should be implemented to help healthcare providers deal with PLHIV without any stigma or discrimination.     

Measuring stigma among health care and social service providers: The HIV/AIDS Provider Stigma Inventory

Initial validation of the HIV/AIDS Provider Stigma Inventory (HAPSI), piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing tendencies to stigmatize and discriminate against people living with HIV/AIDS (PLHA). Derived from social psychology and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labeling, stereotyping, outgrouping, and discriminating. These were enhanced to capture differences associated with personal characteristics of PLHA that trigger secondary stigma (e.g., sexual orientation, injection drug use, multiple sex partners) and fears regarding instrumental and symbolic stigma. Reliabilities were strong (coefficients α for 16 of 19 resulting measures ranged from 0.80 to 0.98) and confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. Evidence of convergent construct validity supported accuracy of primary constructs. Implications for training and professional socialization in health care are discussed.     

A brief HIV stigma reduction intervention for service providers in China

This study assessed the effect of a brief intervention aimed at reducing HIV-related stigma among service providers in China. From December 2005 to June 2006, 138 service providers from four county hospitals in the Yunnan province of China were randomly assigned into either an intervention or a control condition. HIV stigma reduction concepts were conveyed through participatory small group activities, including role-plays, games, group discussions, and testimony by an HIV advocate. Participants were assessed at baseline before the intervention, and at 3- and 6-month follow-ups. Data were analyzed using a logistic regression mixed-effects model. Service providers in the brief intervention condition were significantly more likely to report better protection of patients' confidentiality and right to HIV testing, lower levels of negative feelings toward people living with HIV/AIDS, and more accurate understanding and practice of universal precautions. This brief intervention pilot showed potential in reducing HIV stigma and discrimination among service providers in China. Further intervention trials are needed to test the efficacy and long-term outcomes of this intervention.     

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

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.     

Expressions of HIV-related stigma among rural-to-urban migrants in China

In China, HIV-related stigma is considered as a formidable barrier in the combat against the HIV epidemic. There have been few qualitative investigations on HIV-related stigma in China, especially among a vulnerable population of rural-to-urban migrants. Based on 90 in-depth interviews conducted in 2002-2003 with rural-to-urban migrants in Beijing and Nanjing, China, this study examines the forms and expressions of HIV-related stigma from migrants' perspectives regarding HIV infection and individuals at risk of HIV infection. Consistent with the general framework on stigma, Chinese rural-to-urban migrants' attitudes toward HIV infected individuals take forms of denial, indifference, labeling, separation, rejection, status loss, shame, hopelessness, and fear. These stigmatizing attitudes were mainly derived from fears of AIDS contagion and its negative consequences, fears of being associated with the diseases, and culturally relevant moral judgments. In addition to universal AIDS stigma, both traditional Chinese culture and socially marginalized position of rural migrant population have contributed to culturally unique aspects of stigmatizing attitudes among rural-to-urban migrants. These multifaceted manifestations of HIV-related stigma suggest that HIV stigma reduction intervention needs to address multiple aspects of HIV stigma and stigmatization including personal, cultural, institutional, and structural factors.     

Enhancing attitudes, knowledge and skills of paraprofessional service providers in elder care settings

The preparation of paraprofessional providers of services to older adults is often a "back-burner" issue, even though most direct care of older clients and patients is provided by paraprofessionals. This community-academic project delivered gerontological training to 74 paraprofessional service providers and evaluated the impact of training on gerontological attitudes, knowledge, and skills, and client satisfaction. Key features are that paraprofessional trainees selected training topics, gerontological social workers provided the training, pre- and post-tests assessed the impact of training, and interactive training modeled processes to apply with older adults. Findings suggest that age-related "attitudes" and "skills" can progressively develop, "knowledge" is likely to change sooner, and "client satisfaction" can be enhanced. Future training initiatives can address the value of "reinforcement training," enhancing the capabilities of gerontology and geriatric educators to meet needs of paraprofessionals who influence the quality of later lives.     

Animal bite management practices: a survey of health care providers in a community development block of Haryana

It is seen that outcome of animal bites is influenced by various factors including the treatment procedures practiced by health care providers (HCPs). A cross sectional study of health care providers was conducted during May 2000 in PHC Kurali and Naraingarh town of community development block Naraingarh in district Ambala, Haryana. A total of forty-four HCPs were interviewed at their health facility. They were asked about the qualification and number of years in practice. Health care providers were assessed for their knowledge regarding history taking, immediate management of animal bite, post bite anti-rabies treatment, follow up advice and availability of vaccines. Pre-exposure prophylaxis was known to 18.8% of HCPs. Fifty-nine per cent of HCPs were confident in managing dog bites and 93.1% knew about tissue culture vaccine. Vaccine cost was the commonest barrier (38.8%) in the management of animal bites. This study shows a gross difference between awareness and actual practice of management of animal bites.     

Oral anticoagulant dosing,administration, and storage: a cross-sectional survey of Canadian health care providers

Journal of Thrombosis and Thrombolysis - Direct oral anticoagulant (DOAC) use is increasing worldwide. However, if not taken or prescribed correctly, DOACs have serious side effects. It is crucial...     

HIV-related stigma in a New York City sample of adults in outpatient care for HIV infection: a short report

This analysis used data from a randomly selected cross-sectional sample of HIV infected outpatient adults in New York City to assess HIV-related stigma and examine gender-specific differences among factors associated with HIV-related stigma. Data was collected by conducting participant interviews and medical records abstraction. HIV-related stigma was assessed using the internalized AIDS-related stigma scale (IA-RSS). Exploratory factor analysis of the IA-RSS indicated that the scale consisted of two factors: (1) internalized stigma and (2) anticipated stigma. Of the 447 sampled participants 23.9% had a higher level of internalized stigma and 38.3% had a higher level of anticipated stigma. Multivariate analysis indicated that among females, internalized stigma was associated with being diagnosed HIV positive after the introduction of HAART in 1996 (adjusted prevalence ratio [PR]: 1.9; 95% CI: 1.2, 3.1; P < 0.01) and a diagnosis of depression (adjusted PR: 1.9; 95% CI: 1.2, 2.9; P < 0.01). Among males, anticipated stigma was associated with younger age (18 and 39 years) (adjusted PR: 1.7; 95% CI: 1.3, 2.2; P < 0.001) and use of non-injection drugs (adjusted PR: 0.60; 95% CI: 0.41, 0.86; P < 0.01). Findings suggest that there may be gender-specific differences among factors associated with different dimensions of HIV-related stigma.     

HIV-related stigma within communities of gay men: a literature review

While stigma associated with HIV infection is well recognised, there is limited information on the impact of HIV-related stigma between men who have sex with men and within communities of gay men. The consequences of HIV-related stigma can be personal and community-wide, including impacts on mood and emotional well-being, prevention, testing behaviour, and mental and general health. This review of the literature reports a growing division between HIV-positive and HIV-negative gay men, and a fragmentation of gay communities based along lines of perceived or actual HIV status. The literature includes multiple references to HIV stigma and discrimination between gay men, men who have sex with men, and among and between many gay communities. This HIV stigma takes diverse forms and can incorporate aspects of social exclusion, ageism, discrimination based on physical appearance and health status, rejection and violence. By compiling the available information on this understudied form of HIV-related discrimination, we hope to better understand and target research and countermeasures aimed at reducing its impact at multiple levels.     

HIV-related stigma experiences: Understanding gender disparities in Thailand

This paper assesses the relationship between gender and HIV-related stigma experiences among people living with HIV (PLHIV) – enacted and anticipated stigma – and PLHIV caregivers – courtesy stigma – in Northern Thailand, along with the underlying reasons for stigmatising attitudes towards PLHIV – instrumental and symbolic stigma – expressed in the general population. We used data from the Living With Antiretrovirals (LIWA) study conducted on all PLHIV receiving antiretroviral treatment in four district hospitals in Northern Thailand (n?=?513) and on a community sample of adults from the general population (n?=?500). Women living with HIV and female caregivers of PLHIV reported higher rates of HIV-related stigma experiences than men. Gender interacted with other predictors – the period of HIV diagnosis and age – to increase the level of stigma experienced. Among the general population, attitudes of contact avoidance were infrequent. However, stereotypes depicting PLHIV as blameworthy were highly pervasive, with women perceived as the “victims” of their spouse's irresponsible sexual behaviours. In this context, women were yet more often subjected to HIV-related stigma than men, in particular women diagnosed in the pre-antiretroviral therapy era and younger female caregivers. The role of gender in shaping disparities in HIV-related stigma experiences is discussed.     

Reducing HIV-related stigma among health-care professionals: a game-based experiential approach

Stigmatizing attitudes from health professionals toward people living with HIV (PLHIV) constitute a key barrier to HIV care. Despite considerable progress in HIV stigma-reduction research, we are still searching for effective strategies that can be implemented on a larger scale. To narrow this research gap, the present study investigated a novel cost-effective approach to reducing HIV-related stigma among health professionals. Interactive experiential games were used to help participants gain first-hand experience of potential stressors that PLHIV might encounter. The effectiveness of this game-based experiential approach was compared with that of in vivo contact in reducing HIV-related stigma among students in the health-care fields. Eighty-eight students of health-related programs in Hong Kong were randomly assigned to either the game-based or in vivo contact program. They completed measures of stigmatizing attitudes and HIV/AIDS-related knowledge at pre-program, post-program, and one-month follow-up. Findings showed that the effectiveness of the game-based experiential approach in reducing HIV-related stigma was similar to that of in vivo contact both at post-program and one-month follow-up. Further research is needed to explore the potential value of the game-based approach in reducing HIV stigma among health professionals.     

Triclosan: a review of effectiveness and safety in health care settings

Triclosan is a widely accepted antimicrobial ingredient because of its safety and antimicrobial efficacy. Triclosan is a unique antimicrobial well suited for use in the health care industry in which mildness is a necessity to protect the health care worker during repeated use and antimicrobial activity is a necessity to protect public health. Triclosan has demonstrated immediate, persistent, broad-spectrum antimicrobial effectiveness and utility in clinical health care settings. This review highlights the utility and effectiveness of a 1% triclosan formulation for use in high-risk, high-frequency handwashing.