Post on 20-Jun-2015
description
HIV Stigma Index among Healthcare Workers
General Objective
• To ascertain the HIV knowledge, attitudes and level of stigma & discrimination towards people living with HIV among healthcare workers, in selected healthcare settings in Colombo.
Specific Objective
1. To assess the level of stigma among healthcare providers towards PLHIV
2. To describe the knowledge and general attitudes towards PLHIV
3. To describe the knowledge and practices related to standard precaution
National Hospital of Sri Lanka De Soysa Maternity Hospital Lady Ridgeway Hospital for Children
Castle Street Hospital for Women
Study Setting
National STD/AIDS Control Programme Base Hospital, Angoda
Study Design
• Cross sectional study design
Sampling technique and sample size
• Quota sampling was done considering the relative proportions of healthcare workers.
Institutions: 1. NHSL, 2. DMH, 3. CSHW, 4. LRH, 5.
CSTDC, 6. BH(Angoda) Category of staff: 1. DOCs, 2. NOs, 3. MLTs, 4. ATs, 5. LAs
Category Sample size
Doctors 130
Nursing officers 205
MLTs 92
Attendants 154
Labourers 251
Total 832
Estimated Population: 5898
Sample: 832 (14.1%)
Ethical considerations
• Informed consent
• Voluntary participation/Autonomy
• Confidentiality
• Data security
• Ethical clearance was taken from the ethics committee of the faculty of Medicine, University of Peradeniya
RESULTS
Age distribution
Category of staff Mean age N SD
Doctors 41.73 130 9.737
Nursing staff 39.93 205 10.559
MLTs 38.51 91 9.744
Attendants 48.35 147 6.150
Labourers 38.06 246 11.454
Total 41.01 819 10.612
Mean age of the sample was 41 years (SD, 10.6 years) Range 38-41.7 years
Distribution of the sample by category of staff
Category of staff Frequency Percent Cumulative Percent
Doctors 130 15.6 15.6
Nursing staff 205 24.6 40.3
MLTs 92 11.1 51.3
Attendants 154 18.5 69.8
Labourers 251 30.2 100.0
Total 832 100.0
Over half of the sample is represented by the Nursing staff (24.6%) and hospital labourers (30.2%)
Experience as a healthcare worker
Category of staff Mean years Standard Deviation (Months)
Doctors 13.10 9.7069
Nursing staff 15.70 10.9271
MLTs 13.13 10.0739
Attendants 22.67 6.1455
Labourers 11.06 9.0230
Total 14.90 10.1572
Average years of experience was 15 years
Provision of care to an HIV patient
66.7 67.8
85.9
60.9
43.3
18.6 18.5
3.3
30.5
49.8
14.7 13.7 10.9 8.6 6.9
0
10
20
30
40
50
60
70
80
90
100
Doctors (N=129)
Nursers (N=205)
MLTs (N=92) Attendants (N=151)
Labourers (N=245)
Pe
rce
nt
Have you ever provided care to an HIV patient
Yes No Don't know
Fear of HIV transmission by type of contact with people living with HIV/AIDS
Cause of Stigma & Discrimination
6.2
35.4
60.8
53.5
4.9
23.4
41
34.1
14.3
40
11.7
28.5
62.3
12
32.7
72.7
0 10 20 30 40 50 60 70 80
Touching sweat
Touching saliva
Dressing wounds
Giving inj/drip
Percent
Fear of HIV transmission by type of contact
Labourers Attendants MLTs Nurses Doctors
6.2
4.9
14.3
11.7
12
35.4
23.4
40
28.5
32.7
60.8
41
62.3
72.7
53.5
34.1
0 20 40 60 80
Doctors
Nurses
MLTs
Attendants
Labourers
Percent
Fear of HIV transmission by type of contact
Giving injec/drip Dressing wounds Touching saliva Touching sweat
Morality related attitudes towards PLHIV
Cause of Stigma & Discrimination
6.2
16.2
6.2
55
40
55.4
44.2
2
26.3
5.4
52.2
23.4
47.3
35.1
11
35.2
13.2
58.9
33
50.5
44
13
69.9
61.2
70.8
45.8
79.2
72.7
11.6
66.9
51
62.4
30.8
74.5
69.7
0 20 40 60 80 100
Karume/punishment from God
Punishment for bad behaviours
Ashamed of themselves
Promiscuous men are the once that spread the disease
It is the FSWs who spread the disease
I feel ashamed if I was infected
I feel ashamed if someone in my family infected
Percent
Morality Related Attitudes towards PLHIV
Labourers Attendants MLTs Nurses Doctors
Enacted Stigma (Discrimination)
13.1
57.7
56.2
30
18.5
22.3
41.5
12.2
74.6
66.3
30.7
10.2
29.8
27.3
11
67
63.7
29.7
15.4
18.9
46.2
11.7
82.2
64.7
32
22.9
36.8
6.5
12.4
73.6
63.7
27.1
22.8
31.1
10.1
0 20 40 60 80 100
Receiving less care/attention than other patients
Extra precausions being takenin the sterilization of instruments used for HIV …
Requiring some patients to be tested for HIV before scheduling surgeries
Use of latex gloves unnecessarily for performing external examinations
Pass on the patient to to others
Testing the patient without patient's consent
HCWs gossiping about the patient's HIV status
Percent
In the past 12 months have you seen the following happen in your health facility because a client was known to have or was suspected of having HIV/AIDS
Labourers Attendants MLTs Nurses Doctors
Stigma Index (21-Item Stigma Index)
21-Item Stigma index
• Twenty-one item stigma Index used in this study to measure the level of HIV stigma among healthcare workers.
• Scoring was done on a three-point Likert scale (agree, can’t say, disagree) ranging from 1 to 3 with the score of 21 as minimum and 63 as the maximum score
• The scoring was done according to the responses on the statements in the 21-item stigma scale.
• Higher score on the index denotes a higher level of stigma
Stigmatizing statement
Non Stigmatizing statement
Agree 3 1
Disagree 1 3
Cant say 2 2
HIV Stigma Index among Healthcare workers
Doctors, 33.4
Nursing Officers, 31.6
MLTs, 37.1
Attendants, 37.3
Laboures, 36.9
Stigma Scale (22-63)
21 24 27 30 33 36 39 42 45 48 51 54 57 60 63
Stigma Scale (21-63)
Stig
ma
Ind
ex b
y ca
tego
ry o
f st
aff
HIV/AIDS Knowledge among Healthcare Workers
94.6
94.6
98.5
3.8
4.6
94.1
92.6
93.7
3.4
2
97.8
92.3
91.2
3.3
0
93.5
92.9
78.6
7.8
2.6
92
88
73.3
16
4.8
0 20 40 60 80 100
Can the risk of HIV be reduced by having sex with only one faithful, uninfected partner
Can the risk of HIV be reduced by using condoms
Can a healthy looking person have HIV infection
Can a person get HIV infection from mosquito bites
Can a person get HIV by sharing a meal with someone who infected
Percent
Knowledge on HIV transmission
Labourers Attendants MLTs Nurses Doctors
Occupational exposure to blood Prevalence of percutaneous injuries and splashes
23.1
8.5
11.5
14.1
3.4
12.2
9.9
13.2
15.4
3.2
2.6
2.6
2.4
0.8
2.4
0 20 40 60 80 100
Needle pricks (Contaminated with
blood)
cut with a sharp instrument
(Contaminated with blood)
blood splashes on mm/non-intact skin
Percent
Prevalence of percutaneous injuries or splashes
Labourers Attendants MLTs Nurses Doctors
Knowledge on post-exposure management
70.8
59.2
32
13.1
52.3
80
89.3
56.1
62.9
23.9
79
92.2
69.2
61.5
63.7
9.9
67
82.4
57.1
40.9
44.8
11
59.7
81.2
49.4
49
35.1
13.5
58.2
79.3
0 20 40 60 80 100
Wash with soap and water
Clean wound with sntiseptics
Squeeze/Bleed wounds
Dress the wound
Report to head
Report to infection control staff
Percent
Knowledge on post-exposure management of needle prick injuries
Labourers Attendants MLTs Nurses Doctors
33.3
90.7
56.6
51.9
22.5
48.8
89.8
55.1
61.5
22.9
46.2
90.1
57.1
52.7
33
47.4
77.3
52.6
51.9
26.6
45
71.6
47.4
48.6
21.1
0 20 40 60 80 100
Any needle stick injury
Needle stic injury from an HIV patient
Any blood contact with mucous membranes
Any blood contact with non-intact skin
HIV positive blood contact with intact skin
Percent
Under what circumstances should a healthcare worker seek PEP
Labourers Attendants MLTs Nurses Doctors
What should be done to prevent HIV transmission to Healthcare workers
73.1
7.7
64.6
55.4
21.5
64.6
4.6
77.7
26.2
66.3
18
71.2
62.4
27.8
45.4
1
96.1
22
78
24.2
65.9
54.9
31.9
53.8
4.4
90.1
40.7
42.9
24
74
40.3
34.4
18.8
1.9
63.6
23.4
35.1
20.7
57
30.7
40.2
15.9
2.4
63.3
27.5
0 20 40 60 80 100
Supply enough gloves
Test every patient for HIV
Wear special protections when touching HIV pt's
Have enough clean running water to wash
Inform all hospital workers about HIV pt's
Supply enough PEP
Do not accept HIV pt's to hospitals
Assume that every pt has HIV and always take precausions
HIV patients should have a separate healthcare institution
Percent
In your opinion, what should be done to prevent HIV transmission to HCWs in hospital setting
Labourers Attendants MLTs Nurses Doctors
Conclusions and Recommendations (1 of 5)
• Results showed that about 23%-38% stigma level among healthcare workers
• Prevailing level of HIV stigma and discrimination among HCWs is a reflection of the situation in the society. Therefore, fighting against HIV stigma and discrimination should not be confined to healthcare settings. It should be a broad approach which should include PLHIV, healthcare workers and general population as whole.
Conclusions and Recommendations (2 of 5)
• Fear of HIV transmission is one of the reasons for stigmatizing patients with HIV. It has been observed to be prevalent among all the categories of staff.
• Morality related attitudes are not uncommon among HCWs which is also a cause of stigma
• stigma cannot be eliminated, but discriminatory actions can be eliminated within the healthcare settings (Target - zero discrimination by 2015)
Conclusions and Recommendations (3 of 5)
• It is difficult to expect respectful, stigma free behaviours among HCWs unless they are specially trained to deal with an HIV positive patients
• Most of the time doctors are missing in lot of training interventions. This study showed the importance of inclusion of all the categories of staff for better results
• Although HCWs have the responsibility to adhere to standard precautions and equal rights for treatment care and support, decision makers in the healthcare system should also have the responsibility to make prevention supplies and PEP available.
Conclusions and Recommendations (4 of 5)
• Healthcare providers are not free of misperceptions, misconceptions and judgemental attitudes towards PLHIV which persist in society at large, and need to be addressed
Conclusions and Recommendations (5 of 5)
Healthcare providers should have their own rights to be protected from HIV and ways of
upholding their rights
BUT without denying the rights of PLHIV
Sponsors
Acknowledgement
Principal Investigator: Dr. D Ajith Karawita
Co-investigators: Dr. KAM Ariyaratne, Dr. Manoji Gunathilake
Contributors
Prof. A Pathmeswaran, Dr. Sujatha Samarakoon, Dr. S. Benaragama, , Dr. Sunera Fernando, Mr Hans Billimoria, Mrs Sherine Rodrigo
UN Agencies: Dr. Indira hettiarachchi, Ms. Swairee Rupasinghe, Dr. Dayanath Ranatunge
AIDS Foundation of Lanka: Dr. Palitha Abeykoon, Dr. Sarojini Perera
We would like to acknowledge the support extended by the National STD/AIDS Control Programme, National Hospital of Sri Lanka (NHSL), De Soysa Maternity Hospital (DMH), Lady Ridgeway Hospital for Children (LRH), Castle Street Hospital for Women (CSHW) and Base Hospital Angoda (Infectious Disease Hospital)
Most importantly we, would like to thank all the healthcare workers who participated in the research
Dr. Darshani Wijewickrama and Dr Sathya Herath for translations
Ms Nimali Magammana, Sister Chandrani Kumari Rajakarune, Nalaka Gamage, RW Bandara, Ms. Wasanthi Rajapakse, Ms. Anoma for data collection and data entry.