Santa Fe 2011 Santa Fe, USA 2011
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Abstract #60  -  AIDS stigma among health care providers in urban India: implications for interventions
  Presenting Author:   Dr Maria Ekstrand - University of California
  Additional Authors:  Dr. Shalini Bharat, Dr. Jayashree Ramakrishna,  
AIDS stigma inflicts hardship and suffering on People Living with HIV/AIDS (PLHA) and has been found to reduce the likelihood of HIV testing, medical treatment and disclosure of infections to partners. Stigma attitudes can be particularly harmful in health care settings. This study was designed to examine the prevalence of AIDS stigma and associated factors among health care workers in urban India.
  Method / Issue:
We interviewed 305 physicians, 369 nurses, and 346 ward attendants, who worked in government and private health care settings in Mumbai and Bengaluru; two large cities in states classified as “high prevalence” by the Indian National AIDS Control Organization (NACO). The interviewer-administered survey assessed demographics, felt, symbolic, instrumental and courtesy stigma, as well as endorsement of coercive measures and discrimination toward PLHA in hypothetical situations.
  Results / Comments:
Knowledge of HIV transmission routes was high, with all three groups obtaining mean scores of 6.8 on this 8-point scale. However, misconceptions regarding casual HIV transmission were common, with 20% of physicians, 28% of nurses, and 33% of ward attendants believing HIV could be transmitted by sharing a glass with PLHA, and 11%, 26%, and 32% , respectively, believing HIV can be transmitted by using the same toilets as PLHA. The majority of participants (50% of MDs, 70% of nurses, 83% of ward attendants) agreed with the statement that people who were infected via sex or drugs deserved their infections. Almost all participants endorsed mandatory testing of female sex workers (94-97%) and surgery patients (90-99%). A substantial proportion of physicians stated that HIV-infected men (41%) and women (37%) should not be allowed to get married and that HIV-infected women should not be allowed to have children (55%). These proportions were even greater among nurses (77%, 73% and 76%, respectively) and ward attendants (88%, 86%, 80%, respectively, all p<0.001). Thirteen percent of physicians, compared to 5% of nurses and ward attendants, stated that health workers should be allowed to refuse to treat PLHA (p<0.001). Most participants reported that they would treat PLHA differently from other patients, by taking extra, unnecessary precautions in situations with high likelihood of exposure to infected fluids, including examining an open wound (89% of MDs), drawing blood (88% of nurses), or changing soiled linens (73% of ward attendants). Instrumental stigma scores showed that a significantly greater proportion of participants were worried about acquiring HIV at work than in their personal lives (44% vs. 5% among physicians, 41% vs. 14% among nurses, and 37% vs. 18% among ward attendants, all p<0.001). Multiple regression analyses showed that worries about occupational transmission, negative feelings toward PLHA and transmission misconceptions were significantly associated with AIDS stigma in all groups. Having less frequent contact with PLHA was associated with greater AIDS stigma among physicians and ward attendants, but not among nurses.
These findings demonstrate high levels of AIDS stigma among health care workers in Mumbai and Bengaluru. Interventions that use a human rights framework and involve PLHA as presenters or co-facilitators are needed to correct transmission misconceptions and reduce stigma attitudes and behaviors.
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