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Improving Hospital-Based Quality of Care by Reducing HIV-Related Stigma: Evaluation Results from Vietnam

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Abstract

Operations Research conducted at four hospitals in Vietnam sought to reduce HIV-related stigma and discrimination among hospital workers. The quasi-experimental study compared effects of focusing on ‘fear-based’ stigma (stemming from lack of knowledge) versus both fear-based and social stigma (stemming from moral judgments). Interventions included staff training (ranging from physicians to ward cleaners), hospital policy development, and supplies provision. At baseline (n = 795), reported stigma was substantial (e.g., about half of hospital workers indicated fear of casually touching PLHIV, and felt HIV was a punishment for bad behavior). By endline, stigma measures had improved significantly for both intervention groups (e.g., proportion reporting signs on beds indicating HIV status decreased from 51 to 24 % in Arm 1, and 31 to 7 % in Arm 2), with the combined intervention group showing greater effects. This study highlights successful strategies to reduce stigma, and thus, improve quality of care for PLHIV.

Resumen

Esta investigación de "operaciones" tuvo como objetivo reducir estigma y discriminación asociados con VIH en el personal en cuatro hospitales en Vietnam. El estudio casi-experimental comparó el impacto defocalizar la intervención en el estigma causado por miedo (basado en falta de conocimiento) con el estigma causado por miedo y factores sociales (motivado por valoraciones morales). Las intervencionesincluyeron capacitación del personal (desde médicos a personal de limpieza), desarrollo de políticashospitalarias, y provisión de equipamiento. En la línea de base (n = 795), se encontró que el estigma erasignificativo (ejemplos, aproximadamente la mitad del personal del hospital expresó miedo de tocarcasualmente a personas que viven con VIH, y dijeron que el VIH es un castigo por mala conducta). Alfinal de la intervención, las medidas de estigma mejoraron significativamente en ambos grupos deintervención (por ejemplo, proporcion de personas que reporta letreros en las camas indicando que elestatus del VIH se redujo del 51 al 24 por ciento en Grupo 1, y del 31 al siete por ciento en el Grupo 2), con el agregado que el grupo sujeto a la intervención mixta experimentó mayores cambios. Este estudiomuestra estrategias exitosas para reducir estigma y, por lo tanto, mejorar la calidad del cuidado de laspersonas viviendo con VIH.

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References

  1. Lindan CP, Lieu TX, Giang LT, et al. Rising HIV infection rates in Ho Chi Minh City herald emerging AIDS epidemic in Vietnam. AIDS. 1997;11(Suppl 1):S5–13.

    PubMed  Google Scholar 

  2. National Committee for AIDS, Drugs, and Prostitution Prevention and Control. Viet Nam AIDS Response Progress Report 2012. Hanoi: National Committee for AIDS, Drugs, and Prostitution Prevention and Control, 2012.

  3. Doupe A, Thi Thu Nam N, Poate D. UNAIDS second independent evaluation (2002–2008) country visit to Vietnam. Final Report. Geneva: UNAIDS, 2009.

  4. Vivian FG, Constantine F, Le Van N, et al. Characteristics of high risk HIV-positive IDUs in Vietnam: implications for future interventions. Subst Use Misuse. 2011;46(4):381–9.

    Article  Google Scholar 

  5. Pharris A, Chuc NTK, Tishelman C, et al. Expanding HIV testing efforts in concentrated epidemic settings: a population-based survey from rural Vietnam. PLoS ONE. 2011;6(1):e16017.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Thi MD, Brickley DB, Vinh DT, et al. A qualitative study of stigma and discrimination against people living with HIV in Ho Chi Minh City. Vietnam. AIDS Behav. 2008;12(Suppl 4):S63–70.

    Article  Google Scholar 

  7. Hong KT, Van Anh NT, Ogden J. Because this is the disease of the century: understanding HIV and AIDS-related stigma and discrimination in Vietnam. Washington, DC: ICRW; 2004.

    Google Scholar 

  8. Quach L, Mayer K, McGarvey ST, et al. Knowledge, attitudes, and practices among physicians on HIV/AIDS in Quang Ninh. Vietnam. AIDS Patient CARE STDs. 2005;19(5):335–46.

    Article  Google Scholar 

  9. Reidpath DD, Brijnath B, Chan KY. An Asia Pacific six-country study on HIV-related discrimination: introduction. AIDS Care. 2005;17(Suppl 2):S117–27.

    Article  PubMed  Google Scholar 

  10. Reis C, Heisler M, Amowitz LL. Discriminatory attitudes and practices by health workers towards patients with HIV/AIDS in Nigeria. PLoS Med. 2005;2(8):e246.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Andrewin A, Chien LY. Stigmatization of patients with HIV/AIDS among doctors and nurses in Belize. AIDS Patient Care STDS. 2008;22(11):897–906.

    Article  PubMed  Google Scholar 

  12. Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works? J Int AIDS Soc. 2009;12(1):15.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Vyas KJ, Patel GR, Shukla D, Mathews WC. A comparison in HIV-associated stigma among healthcare workers in urban and rural Gujarat. SAHARA J. 2010;7(2):71–5.

    Article  PubMed  Google Scholar 

  14. Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med. 2003;57(10):13–24.

    Article  PubMed  Google Scholar 

  15. Reda AA, Vandeweerd JM, Syre TR, Egata G. HIV/AIDS and exposure of healthcare workers to body fluids in Ethiopia: attitudes toward universal precautions. J Hosp Infect. 2009;71(2):163–9.

    Article  CAS  PubMed  Google Scholar 

  16. Mill J, Edwards N, Jackson R, Austin W, MacLean L, Reintjes F. Accessing health services while living with HIV: intersections of stigma. Can J Nurs Res. 2009;41(3):168–85.

    PubMed  Google Scholar 

  17. Rintamaki LS, Scott AM, Kosenko KA, Jensen RE. Male patient perceptions of HIV stigma in health care contexts. AIDS Patient Care STDs. 2007;21(12):956–69.

    Article  PubMed  Google Scholar 

  18. Pulerwitz J, Michaelis AP, Weiss E, Brown L, Mahendra VS. Reducing HIV-related stigma: lessons learned from Horizons research and programs. Public Health Rep. 2010;125(2):272–81.

  19. Thanh DC, Moland KM, Fylkesnes K. Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam. BMC Health Serv Res. 2012;12:428.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Kalichman SC, Simbayi LC, Jooste S, et al. Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS Behav. 2005;9(2):135–43.

    Article  PubMed  Google Scholar 

  21. Madan Y, Taruberekera N, Chatora K. Active involvement of PLAs to design and develop mass media campaign to address stigma and discrimination related to HIV and AIDS. PEPFAR Annual Meeting. Durban, South Africa, 2006 [abstract 287].

  22. Campbell C, Nair Y, Maimane S, Sibiya Z. Understanding and challenging HIV/AIDS stigma. HIVAN Community Booklet Series (HIVAN), CfHAN. Durban: University of KwaZulu Natal, 2005.

  23. Liu H, Hu Z, Li X. Understanding interrelationships among HIV-related stigma, concern about HIV infection, and intent to disclose HIV serostatus: a pretest-posttest study in a rural area of eastern China. AIDS Patient Care STDs. 2006;20(2):133–42.

    Article  PubMed  Google Scholar 

  24. Mills EA. Briefing—From the physical self to the social body: expressions and effects of HIV related stigma in South Africa. J Community Appl Soc Psychol. 2006;16:498–503.

    Article  Google Scholar 

  25. Simbayi LC, Kalichman SC, Strebel A, et al. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town. South Africa. Soc Sci Med. 2007;64(9):1823–31.

    Article  Google Scholar 

  26. Turan JM, Miller S, Bukusi EA, Sande J, Cohen CR. HIV/AIDS and maternity care in Kenya: how fears of stigma and discrimination affect uptake and provision of labor and delivery services. AIDS Care. 2008;20(8):938–45.

    Article  CAS  PubMed  Google Scholar 

  27. Pulerwitz J, Michaelis A, Lippman S, Chinaglia M, Diaz J. HIV-related stigma, service utilization, and status disclosure among truck drivers crossing the Southern borders in Brazil. AIDS Care. 2008;20(7):764–70.

    Article  CAS  PubMed  Google Scholar 

  28. Goffman E. Stigma: notes on the management of spoiled identity. Englewood Cliffs: Prentice Hall; 1963.

    Google Scholar 

  29. Kipp W, Bajenja E, Karamagi E, Tindyebwa D. AIDS-related stigma: perceptions of family caregivers and health volunteers in Western Uganda. World Health Popul. 2007;9(2):5–13.

    Article  PubMed  Google Scholar 

  30. Haber DB, Roby JL, High-George LD. Stigma by association: the effects of caring for HIV/AIDS patients in South Africa. Health Soc Care Community. 2011;19(5):541–9.

    Article  PubMed  Google Scholar 

  31. Ha PN, Chuc NT, Hien HT, Larsson M, Pharris A. HIV-related stigma: impact on healthcare workers in Vietnam. Glob Public Health. 2013;8(Suppl 1):S61–74.

    Article  PubMed  Google Scholar 

  32. Brown L, Macintyre K, Trujillo L. Interventions to reduce HIV/AIDS stigma: what have we learned? AIDS Educ Prev. 2003;15(1):49–69.

    Article  PubMed  Google Scholar 

  33. Sengupta S, Banks B, Jonas D, Miles MS, Smith GC. HIV interventions to reduce HIV/AIDS stigma: a systematic review. AIDS Behav. 2011;15:1075–87.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Li L, Zunyou W, Li-Jung L, Chunqing L, et al. Reducing HIV-related stigma in health care settings: a randomized controlled trial in China. Am J Public Health. 2013;103(2):286–92.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? JIAS. 2013;16(Suppl 2):18734.

    Google Scholar 

  36. Herek, GM. Illness, stigma, and AIDS. In: Costa Jr. PT, Vanden Bos GR, eds. Psychological Aspects of Serious Illness: chronic conditions, fatal diseases, and clinical care. Washington, D.C: American Psychological Association, 1990.

  37. Obermeyer C, Makhlouf, Bott S, Carrieri P et al. HIV testing, treatment and prevention: generic tools for operational research. Geneva: World Health Organization, 2009.

  38. Oanh KTH, Ashburn K, Pulerwitz J, Ogden J, Nyblade L. Improving hospital-based quality of care in Vietnam by reducing HIV-related stigma and discrimination. Horizons Final Report. Washington, DC: Population Council, 2008.

  39. Tanzania Stigma-Indicators Field Test Group. Working report: Measuring HIV stigma: Results of a field test in Tanzania. Washington, DC: ICRW/USAID; 2005.

    Google Scholar 

  40. Mahendra V, Gilborn L, Bharat S, Mudoi R, et al. Understanding and measuring AIDS-related stigma in health care settings: A developing country perspective. SAHARA J. 2007;4(2):616–25.

    Article  CAS  PubMed  Google Scholar 

  41. Kidd R, Clay S. Understanding and challenging HIV stigma: toolkit for action. Brighton: International HIV/AIDS Alliance, AED, and ICRW; 2003.

    Google Scholar 

  42. SPSS. PASW Statistics 18, Release Version 18.0.0. Available at www.spss.com.

  43. Knudsen LM. Vietnam. In: Reproductive Rights in a Global Context: South Africa, Uganda, Peru, Denmark, United States, Vietnam, Jordan. Nashville, Tenn.: Vanderbilt UP, 2006.

  44. Institute of Medicine. Crossing the Quality Chasm: A new health system for the 21st century. Washington, DC: National Academy Press; 2001.

    Google Scholar 

  45. UNAIDS. Reducing HIV stigma and discrimination: A critical part of national AIDS programmes: A resource for national stakeholders in the HIV response. Geneva: UNAIDS, 2007.

  46. Mahajan AP, Sayles JN, Patel VA, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS. 2008;22(Suppl 2):S67–79.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This study was made possible by the President’s Emergency Plan for AIDS Relief and the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. HRN-A-00-97-00012-00 (Horizons Program). The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government. The authors would like to acknowledge Pham Duc Muc, of the Department of Therapy, Vietnam Ministry of Health, who provided expert guidance on infection control in the hospital setting; Ross Kidd for documenting the stigma training content and process; Lung Vu, PhD, Population Council, and Joseph Abraham, ScD, independent consultant, who provided input into the statistical analysis; and Sherry Hutchinson, Population Council, for assistance with formatting of the final manuscript. Finally, we give special thanks to all of those in the hospital study sites who so willingly shared their time and experiences with us on such a sensitive topic.

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Author notes

  1. Julie Pulerwitz

    Present address: Population Council, 4301 Connecticut Ave, NW, Suite 280, Washington, DC, 20008, USA

Authors and Affiliations

  1. PATH/Horizons, Washington, DC, USA

    Julie Pulerwitz

  2. ISDS (Institute for Social and Development Studies), Hanoi, Vietnam

    Khuat Thi Hai Oanh

  3. Washington, DC, USA

    Dayo Akinwolemiwa

  4. International Center for Research on Women, Washington, DC, USA

    Kim Ashburn & Laura Nyblade

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  1. Julie Pulerwitz
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Correspondence to Julie Pulerwitz.

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Pulerwitz, J., Oanh, K.T.H., Akinwolemiwa, D. et al. Improving Hospital-Based Quality of Care by Reducing HIV-Related Stigma: Evaluation Results from Vietnam. AIDS Behav 19, 246–256 (2015). https://doi.org/10.1007/s10461-014-0935-4

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