Global Health Division, International Development Group, RTI International.
Health Policy Plus Project.
AIDS. 2020 Sep 1;34 Suppl 1:S93-S102. doi: 10.1097/QAD.0000000000002585.
To describe development and implementation of a three-stage 'total facility' approach to reducing health facility HIV stigma in Ghana and Tanzania, to facilitate replication.
HIV stigma in healthcare settings hinders the HIV response and can occur during any interaction between client and staff, between staff, and within institutional processes and structures. Therefore, the design focuses on multiple socioecological levels within a health facility and targets all levels of staff (clinical and nonclinical).
The approach is grounded in social cognitive theory principles and interpersonal or intergroup contact theory that works to combat stigma by creating space for interpersonal interactions, fostering empathy, and building efficacy for stigma reduction through awareness, skills, and knowledge building as well as through joint action planning for changes needed in the facility environment. The approach targets actionable drivers of stigma among health facility staff: fear of HIV transmission, awareness of stigma, attitudes, and health facility environment.
The results are the three-stage process of formative research, capacity building, and integration into facility structures and processes. Key implementation lessons learned included the importance of formative data to catalyze action and shape intervention activities, using participatory training methodologies, involving facility management throughout, having staff, and clients living with HIV facilitate trainings, involving a substantial proportion of staff, mixing staff cadres and departments in training groups, and integrating stigma-reduction into existing structures and processes.
Addressing stigma in health facilities is critical and this approach offers a feasible, well accepted method of doing so.
描述在加纳和坦桑尼亚实施三阶段“全面设施”方法以减少医疗机构中的艾滋病毒污名化的情况，以促进其复制。
医疗保健环境中的艾滋病毒污名会阻碍艾滋病毒应对工作，并且可能发生在客户与工作人员之间、工作人员之间以及机构内部的流程和结构中。因此，该设计侧重于医疗机构内的多个社会生态层面，并针对所有级别的工作人员（临床和非临床）。
该方法基于社会认知理论原则和人际或群体间接触理论，通过为人际互动创造空间、培养同理心以及通过提高认识、技能和知识来增强减少污名的能力，并通过联合行动计划为医疗机构环境中需要的变革而建立信心，从而对抗污名。该方法针对医疗机构工作人员中可采取行动的污名驱动因素：对艾滋病毒传播的恐惧、对污名的认识、态度和医疗机构环境。
结果是形成性研究、能力建设和融入医疗机构结构和流程的三个阶段过程。关键的实施经验教训包括形成性数据对于激发行动和塑造干预活动的重要性，使用参与式培训方法，在整个过程中让医疗机构管理层参与，让艾滋病毒感染者和患者工作人员进行培训，让大量员工参与，将员工干部和部门混合在培训小组中，并将减少污名化融入现有结构和流程中。
解决医疗机构中的污名问题至关重要，而这种方法提供了一种可行且被广泛接受的方法。
