20th International AIDS Conference - Melbourne, Australia


TUPE289 - Poster Exhibition

Measuring HIV-related stigma and discrimination among health workers in Nyanza Province, Kenya

M. Durojaiye1, J. Turan1, Z. Kwena2, P. Oyaro3, L. Nyblade4,5

1Univ. of Alabama Birmingham, Public Health - Health Care Organization & Policy, Birmingham, United States, 2Kenya Medical Research Institute, Nairobi, Kenya, 3Family AIDS Care and Education Services, Kisumu, Kenya, 4International Development Group, Global Health Division, Washington DC, United States, 5RTI International, Health Policy Project, Washington DC, United States

Background: HIV-related stigma and discrimination pose barriers to accessing HIV testing and treatment services, and stigma in healthcare settings can be especially damaging for people living with HIV (PLHIV). This cross-sectional study is part of a collaboratively funded global effort led by the USAID- and PEPFAR-funded Health Policy Project to develop a brief stigma-measurement tool for health workers. This tool allows assessment and monitoring of stigma in healthcare settings.
Methods: Anonymous questionnaires (self-filled or interviewer-administered, around 20 minutes to complete) were implemented with a convenience sample of 350 health workers at 13 sites in rural Nyanza Province, Kenya, during May-June 2012. We examined the psychometric properties of the sub-scales and associations of stigma variables with provider characteristics using chi-square tests. Next we used multivariate logistic regression to examine the relationships of gender, education, years working in healthcare, and health worker job category with a key indicator of HIV-related values and attitudes: the perception of being infected with HIV as shameful.
Results: Internal consistency reliability of sub-scales in this population was good?Cronbach´s alphas were 0.92 for transmission worry, 0.68 for excessive precautions, 0.76 for observations of discrimination, 0.70 for attitudes and value-driven stigma, and 0.85 for key population stigma. Health workers reported being worried about getting infected with HIV on the job, especially during invasive procedures. For example, 53% were worried when dressing the wounds of PLHIV. Thirty-one percent reported observing health workers talking badly about PLHIV and 29% observed health workers unwilling to care for PLHIV. Health workers reported facing stigma themselves and 67% reported that health workers were hesitant to be tested for HIV. Lay health workers and counselors tended to have less stigmatizing views than clinicians, administrative staff, and technicians. In the multivariate model, lower educational level and male gender were significantly associated with the perception of HIV as shameful.
Conclusions: The brief tool was easy to implement and sub-scales had good reliability in this sample of rural Kenyan health workers. The results revealed the persistence of stigma in health facilities and can be used to advocate for the incorporation of stigma-reduction interventions in healthcare settings.

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