Half of Malaysian doctors admit to some discrimination against patients with HIV

Just over half of physicians at two of Malaysia’s leading medical universities expressed some intention to discriminate against patients with HIV in a survey. Dr Tee Ying Chew of the University of Malaya and colleagues published the results in AIDS and Behavior.

Around 90,000 people are living with HIV in Malaysia, with HIV concentrated among stigmatised groups, including men who have sex with men, people who inject drugs, transgender women and female sex workers. Only 28% of people with HIV receive HIV treatment, with stigma being seen as a barrier to further uptake.

All physicians, working in a range of medical specialities, who were employed at two medical universities were sent the survey, which was completed by 568 of the 1431 physicians. Participants had been practicing medicine for an average of ten years.

Glossary

stigma

Social attitudes that suggest that having a particular illness or being in a particular situation is something to be ashamed of. Stigma can be questioned and challenged.

drug interaction

When a person is taking more than one drug, and drug A interferes with the functioning of drug B. Blood levels of the drug may be lowered or raised, potentially interfering with effectiveness or making side-effects worse. Also known as a drug-drug interaction.

multivariate analysis

An extension of multivariable analysis that is used to model two or more outcomes at the same time.

range

The spread of values, from the smallest to the largest. The inter-quartile range (IQR) only includes the middle 50% of values and measures the degree of spread of the most common values.

occupational exposure

Exposure to HIV as a result of work (job) activities. Exposure may include accidental exposure to HIV-infected blood following a needlestick injury or cut from a surgical instrument

The researchers used a validated scale to measure intention to discriminate against people with HIV, with four items:

  • I am willing to work with HIV+ patients.
  • I am willing to provide the same care to HIV+ patients as other patients.
  • I am willing to do physical exams on HIV+ patients.
  • I am willing to interact with HIV+ patients the same way I interact with other patients.

Strongly agreeing with a statement scored 1; agreeing 2; neutral 3; disagreeing 4 and strongly disagreeing 5.

The mean score on this scale was 1.6, with 54% of doctors having a score greater than 1.0, indicating some intention to discriminate. Furthermore, 4% had a score of 3.0 or higher, indicating a moderate to high intention to discriminate.

In multivariate analysis, the socio-demographic profile of participants (religion, ethnicity, gender etc.) was not associated with intention to discriminate. But doctors working in surgical specialities were more likely to discriminate, perhaps due to greater concerns about occupational exposure.

Physicians with greater discriminatory intent also expressed more negative feelings toward people living with HIV, more HIV-related shame, were more fearful of HIV, and believed that people with HIV do not deserve good care. The researchers say that educational interventions to tackle these kind of attitudes are needed.

References

Tee YC et al. Evaluating Physicians’ Intention to Discriminate Against Patients Living with HIV in Malaysia. AIDS & Behavior, online ahead of print, 2018. (Abstract).

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