Health care facilities that have supportive policies were more likely to have staff offer non-stigmatized services to patients with HIV, according to study results presented at AIDS 2014.
“Stigma reduction is fundamental to strong health systems and ultimately for ensuring access to good quality, equitable care and key HIV outcomes such as uptake of HIV testing, linkage to ART care and adherence to treatment,” Laura Nyblade, PhD, of the Health Policy Project and RTI International, told Infectious Disease News. “Our study demonstrates that despite being 30 years into the epidemic, and despite the knowledge we have about HIV transmission and treatment and the availability of tools like post-exposure prophylaxis, fear of HIV transmission in the workplace, including through actions that carry no risk of HIV transmission, still exists and is related to stigmatizing behaviors.”
Nyblade and colleagues evaluated HIV-related stigma and discrimination among health care workers (HCW) in six countries. In 2012-2013, 1,893 HCWs participated in surveys to determine whether they had a supportive environment in their facilities and whether a supportive environment influenced worry about workplace HIV infections.
The researchers developed two models. In model one, they evaluated the impact of health facility environment on worry about acquiring HIV in job functions such as administering injections, inserting IVs and drawing blood. The health facility environment was measured based on access to post-exposure prophylaxis, adequate infection control supplies and facility policies and procedures to reduce HIV transmission risk. In model two, the researchers analyzed the HCWs’ stigmatizing avoidance behaviors brought on by the worries, including avoiding physical contact, wearing gloves during all aspects of care, wearing double gloves and using additional prevention measures.
More than half of the respondents had an unsupportive facility environment. HCWs who had support on all levels were 46% less likely to worry about acquiring HIV on the job vs. HCWs who had no support or support on only one levels. People who were worried about HIV infection were nearly twice as likely to report stigmatizing avoidance behaviors. These behaviors also applied to functions with no HIV transmission risk: taking temperature or touching clothing of a person with HIV.
Nyblade said that there are three areas at the health facility level for policies and procedures to focus on to alleviate workers’ concerns and the resulting stigmatization. The first is making sure that staff have the supplies they need to protect themselves from exposure and transmission, including gloves and post-exposure prophylaxis. The second is ensuring that there are procedures to implement standard precautions and making sure the staff are trained on them.
Lastly, Nyblade said that policies and procedures need to go beyond standard precautions to address all drivers of stigma, which would also have implications for staff safety and willingness to be tested for HIV and seek treatment with post-exposure prophylaxis when exposed.
“Some staff may be reluctant to access post-exposure prophylaxis because it requires HIV testing and they are afraid of what will happen if they are HIV-positive,” Nyblade said. “Having non-discrimination policies that protect staff who are living with HIV would help this concern.” — by Emily Shafer
For more information:
Nyblade L. #MOAE0302. Presented at: 20th International AIDS Conference; July 20-25, 2014; Melbourne, Australia.
Laura Nyblade, PhD, can be reached at firstname.lastname@example.org.
Disclosure: Nyblade reports no relevant disclosures.