Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia

BMC Public Health Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia Garumma T Feyissa 0 1 Lakew Abebe 1 Eshetu Girma 1 Mirkuzie Woldie 2 0 P. O. Box 1637, Jimma , Ethiopia 1 Department of Health Education and Behavioral Sciences, Jimma University , Jimma , Ethiopia 2 Department of Health Services Management, Jimma University , Jimma , Ethiopia Background: Stigma and discrimination against people living with human immunodeficiency virus (HIV) are obstacles in the way of effective responses to HIV. Understanding the extent of stigma / discrimination and the underlying causes is necessary for developing strategies to reduce them. This study was conducted to explore stigma and discrimination against PLHIV amongst healthcare providers in Jimma zone, Southwest Ethiopia. Methods: A cross-sectional study, employing quantitative and qualitative methods, was conducted in 18 healthcare institutions of Jimma zone, during March 14 to April 14, 2011. A total of 255 healthcare providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support and HIV-related stigma and discrimination. Factor analysis was employed to create measurement scales for stigma and factor scores were used in one way analysis of variance (ANOVA), T-tests, Pearson's correlation and multiple linear regression analyses. Qualitative data collected using key-informant interviews and Focus Group Discussions (FGDs) were employed to triangulate with the findings from the quantitative survey. Results: Mean stigma scores (as the percentages of maximum scale scores) were: 66.4 for the extra precaution scale, 52.3 for the fear of work-related HIV transmission, 49.4 for the lack of feelings of safety, 39.0 for the value-driven stigma, 37.4 for unethical treatment of PLHIV, 34.4 for discomfort around PLHIV and 31.1 for unofficial disclosure. Testing and disclosing test results without consent, designating HIV clients and unnecessary referral to other healthcare institutions and refusal to treat clients were identified. Having in-depth HIV knowledge, the perception of institutional support, attending training on stigma and discrimination, educational level of degree or higher, high HIV case loads, the presence of ART service in the healthcare facility and claiming to be non-religious were negative predictors of stigma and discrimination as measured by the seven latent factors. Conclusions: Higher levels of stigma and discrimination against PLHIV were associated with lack of in-depth knowledge on HIV and orientation about policies against stigma and discrimination. Hence, we recommend health managers to ensure institutional support through availing of clear policies and guidelines and the provision of appropriate training on the management of HIV/AIDS. Stigma and discrimination; Healthcare providers; HIV/AIDS - Background Since the beginning of the HIV epidemic, stigma and discrimination have been identified as the major obstacles in the way of effective responses to HIV. HIVrelated stigma and discrimination is a complex social process that interacts with, and reinforces, the preexisting stigma and discrimination associated with sexuality, gender, race and poverty [1-4]. HIV/AIDS-related stigma and discrimination occur everywhere, but they may have more serious consequences in healthcare settings [5]. A disadvantage stemming from stigma goes beyond what are often understood as discriminatory actions. These can include -the perception that they are not at risk of the disease for those who do not know their HIV status. And for PLHIV, they can include internalized stigma, lowered self esteem, depression, and changes in behavior (e.g., not using the available services) because of the fear of stigma [6,7]. It was indicated that higher perceived HIV stigma scores amongst clients with HIV were significantly and negatively correlated with the quality of life [8]. Stigma reduced participation in programmes to prevent mother-to-child transmission of HIV (PMTCT) [9-12]. It also affects the attitudes of providers who deliver HIV-related care [6,7,13-20]. Service providers in healthcare institutions are expected to provide social and psychological support to persons living with HIV (PLHIV) in order to help them cope with stress and to reduce the stigma directed against PLHIV. However, HIV/AIDS-related stigma and discrimination have been extensively documented amongst healthcare providers. There have been many reports from healthcare settings of HIV testing without consent, breaches of confidentiality, labeling, gossip, verbal harassment, differential treatment and even denial of treatment [5,11,13-25]. People who feel stigmatized by healthcare providers face problems getting tested for HIV and accessing optimal healthcare services. The fear of stigma impedes prevention efforts, including discussions of safer sex and PMTCT [5,12,19,26-34]. Effectively addressing stigma removes what still stands as a roadblock to concerted action, whether at local, community, national or global level. Efforts to reduce stigma and discrimination related to HIV/AIDS will not only help countries reach key targets for universal access and Millennium Development Goal 6, they will also protect and promote human rights, foster respect for PLHIV and other affected groups, and reduce the transmission of HIV. The reduction of the HIV/AIDS-related stigma and discrimination amongst healthcare providers will be helpful not only for the marginalized groups, PLHIV and their associates, but also for the healthcare providers themselves. Studies indicate that healthcare providers delay from accessing healthcare services because of the fear of stigma and discrimination [35-40]. Understanding the magnitude of, and causes underlying HIV-related stigma and discrimination amongst health workers is necessary for developing anti-stigma strategies and programs [35,39,41]. Nevertheless, in Ethiopia only little knowledge exists about HIV/AIDS-related stigma and discrimination amongst healthcare providers. In addition, the previous study in Ethiopia did not utilize psychometric approaches to measure the degree of HIV/AIDS-related stigma and discrimination. In order to combat stigma and discrimination, it is important to quantify them, to understand their magnitudes, to explore their associated factors and to explore how they vary across groups, settings and cultural contexts within a country [10]. Furthermore, no single published study has adressed the issue of HIV/AIDS-related stigma and discrimination amongst healthcare providers in healthcare institutions of Jimma zone. This study was conducted to explore stigma and discrimination against PLHIV amongst healthcare providers in Jimma zone, Southwest Ethiopia. The study context In Ethiopia, in 2009, there were estimated to be 1.2 million PLHIV, with an adult HIV prevalence of 2.4%. The HIV/AIDS epidemic in Et (...truncated)