Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions
Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions
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DOI：
10.7448/ias.16.3.18717
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发表时间：
2013-11-01
影响因子：
6
通讯作者：
Heylen, Elsa
中科院分区：
文献类型：
--
作者：
Ekstrand, Maria L.;Ramakrishna, Jayashree;Heylen, Elsa
简介：艾滋病毒耻辱给艾滋病毒感染者 (PLHIV) 带来困难和痛苦，并干扰预防和治疗工作。卫生专业人员经常被艾滋病毒感染者称为耻辱的重要来源。本研究旨在调查印度艾滋病毒高流行州不同城市医疗机构中医生、护士和病房工作人员耻辱和歧视的发生率和驱动因素。 方法：这项横断面研究招募了印度孟买和班加罗尔政府和非政府医疗机构的 305 名医生、369 名护士和 346 名病房工作人员。大约一小时长的访谈重点关注与艾滋病毒传播相关的知识、艾滋病毒感染者的个人和职业经历、工具性和象征性耻辱、对强制性政策的认可，以及在涉及高风险和低风险液体接触的职业和个人情况下的歧视意图。结果：所有群体都报告了高程度的耻辱。其中包括愿意禁止女性感染者生育孩子（55％至80％），支持对女性性工作者（94％至97％）和手术患者（90％至99％）进行强制检测，并表示通过性或毒品感染艾滋病毒的人“得到了他们应得的”（50％至83％）。此外，89％的医生，88％的护士和73％的病房工作人员表示他们会歧视艾滋病毒携带者在涉及液体接触的可能性很高的职业环境中，57%的医生、40%的护士和71%的病房工作人员表示，他们在低风险情况下也会这样做。耻辱和歧视的显着且可改变的驱动因素包括与艾滋病毒携带者接触的频率较低，以及更多的传播误解、指责、工具性和象征性耻辱，所有三个组的参与者都报告了对强制措施的高支持率和歧视意图。艾滋病毒感染者的耻辱和歧视与多种可改变的驱动因素有关，这与之前的研究一致，并且需要在未来的干预措施中瞄准。结论：针对印度城市医疗保健提供者的减少耻辱干预计划需要解决对传播的恐惧，提高普遍的预防技能，并让艾滋病毒感染者参与干预的各个阶段，以减少象征性耻辱并确保教授相关的患者互动技能。
Introduction: HIV 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.Methods: This 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.Results: High 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.Conclusions: Stigma 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.