HIV Stigma and Self-Efficacy Caring for Women Living With HIV: A Mixed-Methods Study of Labour and Delivery Providers-Empirical Research Mixed Methods.

AIM

To understand HIV stigma and self-efficacy of labour and delivery (L&D) providers in caring for women living with HIV (WLHIV).

DESIGN

Cross-sectional descriptive mixed methods.

METHODS

Data were collected in six primary healthcare facilities in the Kilimanjaro region, Tanzania between February and November 2022. We conducted eight focus groups with L&D providers (n = 36) and nurse-midwifery students (n = 12). We conducted surveys with 60 L&D providers assessing HIV stigma (fear of acquisition, extra precautions and attitudes) and self-efficacy in caring for WLHIV. Qualitative findings were complemented by survey data to provide a comprehensive understanding of providers' attitudes and experiences.

RESULTS

Providers expressed fear of HIV acquisition when caring for WLHIV. Almost all providers noted that they used extra precautions with WLHIV; 97% used double gloves and 39% avoided touching WLHIV with bare hands, even when there were no bodily fluids. Most providers had positive attitudes towards WLHIV. Almost all rejected the idea that HIV was a punishment for bad behaviour, but 44% thought their patients might not be careful about infecting others. Qualitative data suggested providers worried that patients' reluctance to disclose their HIV status could raise the risk of occupational exposure. Provider self-efficacy in normal birth was lower when caring for a woman with HIV compared with care for women who are HIV-negative but did not differ significantly in other situations.

CONCLUSION

This study showed that providers had generally low-stigmatising attitudes towards people living with HIV but feared occupational exposure, leading to avoidance of necessary patient contact. Training on clinical and interpersonal skills, coupled with evidence-based care for women with HIV during childbirth, could benefit both providers and patients.

REPORTING METHOD

The study is reported following the Good Reporting of a Mixed-Methods Study (GRAMMS) checklist.

PATIENT OR PUBLIC CONTRIBUTION

Patients and the public were not involved in this research.