HIV stigma index among healthcare workers, Sri Lanka

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


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


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


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


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


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


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


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.


• 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)


• 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.


• Healthcare providers are not free of misperceptions, misconceptions and judgemental attitudes towards PLHIV which persist in society at large, and need to be addressed


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

HIV stigma index among healthcare workers, Sri Lanka

Health & Medicine

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