20th International AIDS Conference - Melbourne, Australia


LBPE50 - Poster Exhibition

Reducing HIV-related stigma and discrimination in health care settings: an initiative from Thailand

N. Pudpong1, P. Prakongsai1, K. Srithanaviboonchai2, S. Chariyalertsak2, C. Chariyalertsak3, P. Smutraprapoot4, P. Sirinirund5, T. Siraprapasiri6, S. Ongwandee7, P. Benjarattanaporn8, B. Otto9, L. Nyblade10

1International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand, 2Research Institute for Health Sciences (RIHES), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 3Disease Control Department, Chiang Mai Provincial Health Office, Thailand, Chiang Mai, Thailand, 4Bureau of AIDS, TB, and STI, Bangkok Metropolitan (BMA), Thailand, Bangkok, Thailand, 5Department of Disease Control, Ministry of Public Health, Thailand, Nonthaburi, Thailand, 6National AIDS Management Centre (NAMc), Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand, 7Bureau of AIDS, TB and STIs (BATS), Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand, 8UNAIDS, Bangkok, Thailand, 9RTI, International, Jakarta, Indonesia, 10RTI, International, Washington, United States

Background: Thailand provides free, universal access to HIV treatment yet AIDS deaths remain steady (>20,000 p.yr) for the past 7 years, with average start time on treatment at low CD4 counts(86cell/mm3). Stigma and discrimination(S&D) contributes to low HIV testing rates and late entry into HIV care. Therefore, Thailand has made S&D-reduction a key goal in its HIV/AIDS strategy and is rolling out a national S&D-reduction plan, beginning with health-care settings.
Description: Thailand''s S&D-reduction plan includes: 1)inclusion of a S&D-reduction goal in the national strategy; 2)data collection to establish baseline levels of S&D, inform intervention design, and track progress; 3)design and implementation of S&D-reduction interventions. Progress is now being made on step two, with completion of a pilot-study to test health-facility and PLHIV S&D measurement tools, supported by ILO and USAID. These allow for scaled-up data collection in 5 target provinces and inform design of S&D-reduction interventions. The study included: adaptation of a globally-tested questionnaire; data collection (Jan-March,2014) with health-facility staff(n=738) and PLHIV(n=715); data analysis for questionnaire reduction and intervention design.
Lessons learned: Elevating S&D-reduction as a specific goal in the national strategy is essential to mobilizing resources and action on S&D. Having brief, comprehensive measurement tools to facilitate scale-up of data collection is a necessary step in the intervention process. The study demonstrated that adaptation of a global tool to the Thai context is feasible and valid. While a small sample, the results indicate presence of both drivers of and enacted S&D. Worry of contracting HIV infection, which drives use of unnecessary ''preventive'' behaviors that are stigmatizing and disclose patients HIV status, were both high, as were stigmatizing attitudes. Enacted stigma was also reported. Reducing S&D in health-facilities will require addressing both fears of HIV transmission as well as stigmatizing attitudes.

Key FindingsWorry of contracting HIV through touching clothing, bedding or personal belongings of PLHIVReporting routine use of double gloves with patients living with HIVReporting observing health providers avoiding caring for PLHIV in the past 12 months in their facilityAgreement with the statement: PLHIV should be ashamed of themselves
% of all respondents (N=738)34.7%31.8%18.4%42.5%
[Table 1: Key Findings]

Conclusions/Next steps: Thailand''s experience provides key lessons: the importance of elevating S&D as its own goal in the national strategy and the necessity and feasibility of data collection to support scale-up of S&D-reduction programming. Future lessons will be learned about implementing S&D-reduction interventions at scale.

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