Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.
BMC Public Health. 2012 Jul 13;12:522. doi: 10.1186/1471-2458-12-522.
Stigma and discrimination against people living with human immunodeficiency virus (HIV) are obstacles in the way of effective responses to HIV. Understanding the extent of stigma / discrimination and the underlying causes is necessary for developing strategies to reduce them. This study was conducted to explore stigma and discrimination against PLHIV amongst healthcare providers in Jimma zone, Southwest Ethiopia.
A cross-sectional study, employing quantitative and qualitative methods, was conducted in 18 healthcare institutions of Jimma zone, during March 14 to April 14, 2011. A total of 255 healthcare providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support and HIV-related stigma and discrimination. Factor analysis was employed to create measurement scales for stigma and factor scores were used in one way analysis of variance (ANOVA), T-tests, Pearson's correlation and multiple linear regression analyses. Qualitative data collected using key-informant interviews and Focus Group Discussions (FGDs) were employed to triangulate with the findings from the quantitative survey.
Mean stigma scores (as the percentages of maximum scale scores) were: 66.4 for the extra precaution scale, 52.3 for the fear of work-related HIV transmission, 49.4 for the lack of feelings of safety, 39.0 for the value-driven stigma, 37.4 for unethical treatment of PLHIV, 34.4 for discomfort around PLHIV and 31.1 for unofficial disclosure. Testing and disclosing test results without consent, designating HIV clients and unnecessary referral to other healthcare institutions and refusal to treat clients were identified. Having in-depth HIV knowledge, the perception of institutional support, attending training on stigma and discrimination, educational level of degree or higher, high HIV case loads, the presence of ART service in the healthcare facility and claiming to be non-religious were negative predictors of stigma and discrimination as measured by the seven latent factors.
Higher levels of stigma and discrimination against PLHIV were associated with lack of in-depth knowledge on HIV and orientation about policies against stigma and discrimination. Hence, we recommend health managers to ensure institutional support through availing of clear policies and guidelines and the provision of appropriate training on the management of HIV/AIDS.
对艾滋病毒感染者的污名化和歧视是有效应对艾滋病毒的障碍。了解污名/歧视的程度及其根本原因对于制定减少污名化和歧视的策略是必要的。本研究旨在探索埃塞俄比亚西南部吉姆马地区医疗保健提供者对艾滋病毒感染者的污名化和歧视。
采用定量和定性方法，于 2011 年 3 月 14 日至 4 月 14 日在吉姆马地区的 18 家医疗机构进行了横断面研究。共有 255 名医疗保健提供者对调查问卷做出了回应，问卷内容涉及社会人口学特征、艾滋病毒知识、感知机构支持以及与艾滋病毒相关的污名化和歧视。采用因子分析创建了污名化的测量量表，并使用单向方差分析（ANOVA）、t 检验、皮尔逊相关和多元线性回归分析对因子得分进行了分析。使用关键知情者访谈和焦点小组讨论（FGD）收集的定性数据与定量调查结果进行了三角分析。
平均污名化得分（最高量表得分的百分比）分别为：额外预防措施量表为 66.4%，对工作中艾滋病毒传播的恐惧为 52.3%，缺乏安全感为 49.4%，价值观驱动的污名为 39.0%，不道德对待艾滋病毒感染者为 37.4%，与艾滋病毒感染者相处时感到不适为 34.4%，非官方泄露为 31.1%。确定了未经同意进行检测和披露检测结果、指定艾滋病毒感染者、不必要地将其转介到其他医疗机构以及拒绝治疗患者的行为。具有深入的艾滋病毒知识、感知机构支持、参加关于污名化和歧视的培训、具有学位或更高学历、高艾滋病毒病例数、在医疗保健机构提供抗逆转录病毒治疗服务以及声称不信教，这些因素是与七个潜在因素衡量的污名化和歧视的负相关因素。
对艾滋病毒感染者的污名化和歧视程度较高与缺乏对艾滋病毒的深入了解以及对反污名化和歧视政策的认识有关。因此，我们建议卫生管理人员通过提供明确的政策和准则以及提供适当的艾滋病毒/艾滋病管理培训来确保机构支持。
