HIV-Related Stigma Among Healthcare Providers in Different Healthcare Settings: A Cross-Sectional Study in Kerman, Iran

Document Type : Original Article

Authors

1 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

3 Department of Sociology, Allameh Tabatabai University, Tehran, Iran

4 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

5 Department of Internal Medicine, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

6 Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

7 Department of Ophthalmology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

8 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

9 Department of Epidemiology & Biostatistics, The University of Western Ontario, London, ON, Canada

10 Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

Abstract

Background
Stigmatizing attitudes among healthcare providers are an important barrier to accessing services among people living with HIV (PLHIV). This cross-sectional study aimed to assess the status and correlates of HIV-related stigma among healthcare providers in Kerman, Iran.

 
Methods
Using a validated and pilot-tested stigma scale questionnaire, we measured HIV-related stigma among 400 healthcare providers recruited from three teaching hospitals (n = 363), private sectors (n = 28), and the only voluntary counseling and testing (VCT) center (n = 9) in Kerman city. Data were gathered using self-administered questionnaires at participants’ workplace during Fall 2016. To examine the correlates of stigmatizing attitudes, we constructed bivariable and multivariable linear regression models.

 
Results
The mean ± standard deviation (SD) of stigma score was 25.95 ± 7.20 out of the possible 50, with higher scores reflecting more stigmatizing attitudes. Paramedics, nurses’ aides, and housekeeping staff had the highest, and VCT personnel had the lowest average stigma scores, respectively. Multivariable regression analyses showed that prior experience of working with PLHIV (β = -2.48; P = .03), exposure to HIV-related educational courses (β = -2.03; P = .02), and P < .001) were associated with lower stigma scores.

 
Conclusion
Our findings highlight the need for health managers to provide training opportunities for healthcare providers, including programs that focus on improving HIV-related knowledge for healthcare providers. Enforcing policies that aim to reduce HIV-related stigma and discrimination among healthcare providers in Iran are urgently needed.

Keywords

Main Subjects


  1. HIV/AIDS Fact sheets. Word Health Organization Web site.  http://www.who.int/news-room/fact-sheets/detail/hiv-aids. Accessed August 16, 2018.
  2. Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works? J Int AIDS Soc. 2009;12:15. doi:10.1186/1758-2652-12-15 
  3. Yuh JN, Ellwanger K, Potts L, Ssenyonga J. Stigma among HIV/AIDS patients in Africa: a critical review. Procedia Soc Behav Sci. 2014;140:581-585. doi:10.1016/j.sbspro.2014.04.474 
  4. Zarei N, Joulaei H, Darabi E, Fararouei M. Stigmatized attitude of healthcare providers: a barrier for delivering health services to HIV positive patients. Int J Community Based Nurs Midwifery. 2015;3(4):292-300.
  5. Mohseni Tabrizi A, Hekmatpour P. HIV/AIDS related stigma in Iran: a qualitative study. IAU Internation Journal of Social Sciences. 2016;6(2):13-19.
  6. Dowshen N, Binns HJ, Garofalo R. Experiences of HIV-related stigma among young men who have sex with men. AIDS Patient Care STDS. 2009;23(5):371-376. doi:10.1089/apc.2008.0256 
  7. Lorenc T, Marrero-Guillamón I, Llewellyn A, et al. HIV testing among men who have sex with men (MSM): systematic review of qualitative evidence. Health Educ Res. 2011;26(5):834-846. doi:10.1093/her/cyr064
  8. Karamouzian M, Madani N, Doroudi F, Haghdoost AA. Improving the quality and quantity of HIV data in the Middle East and North Africa: key challenges and ways forward. Int J Health Policy Manag. 2017;6(2):65-69. doi:10.15171/ijhpm.2016.112
  9. Haghdoost AA, Mostafavi E, Mirzazadeh A, et al. Modelling of HIV/AIDS in Iran up to 2014. J AIDS HIV Res. 2011;3(12):231-239. doi:10.5897/jahr11.030
  10. Karamouzian M, Akbari M, Haghdoost AA, Setayesh H, Zolala F. "I am dead to them": HIV-related stigma experienced by people living with HIV in Kerman, Iran. J Assoc Nurses AIDS Care. 2015;26(1):46-56. doi:10.1016/j.jana.2014.04.005 
  11. Sajadi L, Mirzazadeh A, Navadeh S, et al. HIV prevalence and related risk behaviours among female sex workers in Iran: results of the national biobehavioural survey, 2010. Sex Transm Infect. 2013;89 Suppl 3:iii37-40. doi:10.1136/sextrans-2013-051028
  12. Andrewin A, Chien LY. Stigmatization of patients with HIV/AIDS among doctors and nurses in Belize. AIDS Patient Care STDS. 2008;22(11):897-906. doi:10.1089/apc.2007.0219 
  13. Feyissa GT, Abebe L, Girma E, Woldie M. Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health. 2012;12:522. doi:10.1186/1471-2458-12-522
  14. Stringer KL, Turan B, McCormick L, et al. HIV-related stigma among healthcare providers in the deep south. AIDS Behav. 2016;20(1):115-125. doi:10.1007/s10461-015-1256-y
  15. Amuri M, Mitchell S, Cockcroft A, Andersson N. Socio-economic status and HIV/AIDS stigma in Tanzania. AIDS Care. 2011;23(3):378-382. doi:10.1080/09540121.2010.507739
  16. Rahmati-Najarkolaei F, Niknami S, Aminshokravi F, et al. Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran. J Int AIDS Soc. 2010;13:27. doi:10.1186/1758-2652-13-27
  17. Nyblade L, Jain A, Benkirane M, et al. A brief, standardized tool for measuring HIV-related stigma among health facility staff: results of field testing in China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis. J Int AIDS Soc. 2013;16(3 Suppl 2):18718. doi:10.7448/ias.16.3.18718
  18. Dohoo IR, Martin SW, Stryhn H. Methods in epidemiologic research. Charlottetown, Prince Edward Island: VER Inc; 2012.
  19. Bamorovat M, Sharifi I, Aflatoonian MR, et al. Risk factors for anthroponotic cutaneous leishmaniasis in unresponsive and responsive patients in a major focus, southeast of Iran. PLoS One. 2018;13(2):e0192236. doi:10.1371/journal.pone.0192236  
  20. Zolala F, Mahdavian M, Haghdoost AA, Karamouzian M. Pathways to addiction: a gender-based study on drug use in a triangular clinic and drop-in center, Kerman, Iran. Int J High Risk Behav Addict. 2016;5(2):e22320. doi:10.5812/ijhrba.22320 
  21. Oskouie F, Kashefi F, Rafii F, Gouya MM. Qualitative study of HIV related stigma and discrimination: What women say in Iran. Electron Physician. 2017;9(7):4718-4724. doi:10.19082/4718 
  22. Doka PJS, Danjin M, Dongs IS. HIV/AIDS-related stigma and discrimination among health-care providers in a tertiary health facility. J Med Sci. 2017;37(2):44-49. doi:10.4103/jmedsci.jmedsci_99_16
  23. Letamo G. The discriminatory attitudes of health workers against people living with HIV. PLoS Med. 2005;2(8):e261. doi:10.1371/journal.pmed.0020261
  24. Lau JT, Tsui HY. Discriminatory attitudes towards people living with HIV/AIDS and associated factors: a population based study in the Chinese general population. Sex Transm Infect. 2005;81(2):113-119. doi:10.1136/sti.2004.011767
  25. Rogowska-Szadkowska D, Oltarzewska AM, Sawicka-Powierza J, Chlabicz S. Medical care of HIV-infected individuals in Poland: impact of stigmatization by health care workers. AIDS Patient Care STDS. 2008;22(1):81-84. doi:10.1089/apc.2007.0239
  26. Visser MJ, Makin JD, Vandormael A, Sikkema KJ, Forsyth BW. HIV/AIDS stigma in a South African community. AIDS Care. 2009;21(2):197-206. doi:10.1080/09540120801932157
  27. Lee MB, Wu Z, Rotheram-Borus MJ, Detels R, Guan J, Li L. HIV-related stigma among market workers in China. Health Psychol. 2005;24(4):435-438. doi:10.1037/0278-6133.24.4.435 
  28. Malekinejad M, Mohraz M, Razani N, et al. High HIV prevalence in a respondent-driven sampling survey of injection drug users in Tehran, Iran. AIDS Behav. 2015;19(3):440-449. doi:10.1007/s10461-014-0904-y
  29. Pulerwitz J, Oanh KT, Akinwolemiwa D, Ashburn K, Nyblade L. Improving hospital-based quality of care by reducing HIV-related stigma: evaluation results from Vietnam. AIDS Behav. 2015;19(2):246-256. doi:10.1007/s10461-014-0935-4
  30. Pulerwitz J, Michaelis A, Weiss E, Brown L, Mahendra V. Reducing HIV-related stigma: lessons learned from Horizons research and programs. Public Health Rep. 2010;125(2):272-281. doi:10.1177/003335491012500218
  31. Li L, Wu Z, Wu S, Zhaoc Y, Jia M, Yan Z. HIV-related stigma in health care settings: a survey of service providers in China. AIDS Patient Care STDS. 2007;21(10):753-762. doi:10.1089/apc.2006.0219
  32. Feyissa GT, Lockwood C, Woldie M, Munn Z. Reducing HIV-related stigma and discrimination in healthcare settings: A systematic review of quantitative evidence. PLoS One. 2019;14(1):e0211298. doi:10.1371/journal.pone.0211298
Volume 9, Issue 4
April 2020
Pages 163-169
  • Receive Date: 24 September 2018
  • Revise Date: 24 July 2019
  • Accept Date: 14 October 2019
  • First Publish Date: 01 April 2020