Health care providers must respond to HIV-related stigma

Healthcare providers can and must respond to HIV-associated stigma and discrimination, a review article published in the Journal of the International AIDS Society emphasises.

“Stigma reduction in health facilities … has important implications for improving patient-provider interactions, improving quality of care, and creating a safe and supportive space for clients that can help them deal with, and in some cases challenge stigma from family and community members”, write the authors.

HIV and stigma

HIV is both preventable and treatable. However people with and at risk of HIV often experience stigma and discrimination. This can mean that they are deterred from using prevention, care and treatment services.

All too often, such stigma and discrimination is experienced in healthcare facilities. The authors describe this as “pernicious” and suggest “its physical and mental health consequences to patients can be damaging.”

Unfortunately, little attention has been paid to HIV-related stigma and discrimination in health care. This is especially the case for resource-limited settings.

The authors suggest that this lack of attention can be attributed to three causes:

• Lack of awareness about the consequences
• Lack of capacity to respond
• A misconception that the issue is too widespread to be changed.

Therefore, they outline in their paper the reasons why it is important to address real and perceived stigma in healthcare settings. They also provide examples of ways in which facilities in resource-limited settings have addressed stigma and discrimination.

A definition of stigma

UNAIDS defines HIV-related stigma and discrimination thus: “a process of devaluation of people either living with or associated with HIV and AIDS…Discrimination follows stigma and is the unfair and unjust treatment of an individual based on his or her real or perceived HIV status.”

How stigma and discrimination are manifested

Studies in Tanzania, Ethiopia, and India have shown that stigma and discrimination towards people with HIV can be manifested in a number of ways, including:

• Neglect
• differential treatment
• Denial of treatment
• Testing and disclosure without consent
• Avoidance
• Unwarranted infection control procedures
• Making moral judgments.

Such behaviour can have “potentially devastating consequences on care-seeking behaviour”, suggest the investigators, meaning that “stigma represents a major cost for both individuals and public health".

This can include avoidance of prevention, testing, care and treatment services.

Fear of stigma can mean that healthcare workers who are HIV-positive or at risk of HIV can be especially reluctant to access services because they fear the reaction of colleagues.

Tackling the causes of stigma and discrimination

Studies from around the world have revealed three ways in which stigma and discrimination can be immediately challenged:

• Raise awareness of what stigma looks like and what its consequences may be.
• Provision of information about HIV transmission, addressing unwarranted fears about the risk of infection with HIV after casual contact.
• Emphasise that something can be done about the issue.

“What is needed…is the political will and resources to support and scale up stigma reduction activities throughout healthcare settings globally,” conclude the investigators. They add, “given the detrimental effect of stigma on both individual health and wellbeing and public health outcomes, it is clear that healthcare managers cannot afford inaction any longer.”