20th International AIDS Conference - Melbourne, Australia


MOAE0302 - Oral Abstract

Creating stigma-free health facilities: lack of HIV care policies, protocols, materials, exacerbate health worker fear of HIV transmission and stigmatizing avoidance behaviors, evidence from 6 countries

Presented by Laura Nyblade (United States).

L. Nyblade1, A. Jain2, M. Benkirane3, L. Li4, A.-L. Lohiniva3, R. Mclean5, J.M. Turan6, N. Varas-Díaz7

1Health Policy Project and RTI, International, Global Health, Washington, United States, 2Health Policy Project and Futures Group, Washington, United States, 3Global Disease Detection and Response Program at the U.S Naval Medical Research Unit no 3., Cairo, Egypt, 4University of California, Psychiatry and Biobehavioral Sciences and Epidemiology, School of Public Health, Semel Institute - Center for Community Health, Los Angeles, United States, 5University of the West Indies St. Augustine Campus, Centre for Health Economics, Faculty of Social Sciences, Port-of-Spain, Trinidad and Tobago, 6University of Alabama at Birmingham, Department of Health Organization and Policy, School of Public Health, Birmingham, United States, 7University of Puerto Rico, Center for Social Research, Social Sciences Faculty, San Juan, Puerto Rico

Background: When a health facility has policies, protocols, and adequate supplies to reduce health workers'' risk of HIV infection, it is more likely staff will offer non-stigmatizing services to HIV-positive patients.
Methods: Surveys were implemented in 2012-2013 to measure HIV-related stigma and discrimination among all levels of healthcare staff (N=1893, 72% female) in six country settings (China, Dominica, Egypt, Kenya, Puerto Rico, and St. Christopher/Nevis) through a co-funded partnership led by the USAID and PEPFAR-funded Health Policy Project. We hypothesized that an unsupportive facility environment (lack of clear HIV policies, protocols, supplies, information) increases staff worry about workplace HIV infection, leading to the adoption of stigmatizing behaviors. We ran bivariate analysis and two multivariate logistic regression models adjusted for respondent characteristics and country. Model I''s primary predictor was health facility environment based on: access to post-exposure prophylaxis, adequate infection-control supplies, and presence of facility procedures/policies that reduce HIV transmission risk. The dependent variable was worry about acquiring HIV in job functions based on: worry about administering injections, inserting IVs, and drawing blood. Model II''s primary predictor was worry about acquiring HIV in job function. The dependent variable was stigmatizing avoidance behaviors including: avoiding physical contact, wearing gloves during all aspects of patient care, wearing double gloves, and use of additional prevention measures with HIV-positive patients.
Results: Over half of respondents reported an unsupportive facility environment. Staff who reported support on all items have a 46% (p-value=0.02) lower odds of worry about acquiring HIV on the job than staff who reported no support or support one item. Respondents who were worried about HIV infection were 1.96 (p-value =0.00) times more likely to report stigmatizing avoidance behaviors. These relationships were also strong when we used two job functions that have no risk of HIV transmission (taking temperature or touching clothing of an HIV-positive patient).
Conclusions: Interventions should ensure that facilities are creating supportive workplaces with strong policies and providing staff with information and supplies to reduce fear and risk of workplace HIV infection. This in turn could improve quality of care by reducing stigmatizing avoidance behaviors that visibly identify HIV-positive patients and break confidentiality.

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