Horizons Projects | Reducing HIV/AIDS-related Stigma and Discrimination in the Health Care Setting in Vietnam

HORIZONS PROJECT
Reducing HIV/AIDS-related Stigma and Discrimination in the Health Care Setting in Vietnam

AIDS-related stigma and discrimination are pervasive problems worldwide, particularly in the health care setting. They are known to be barriers to HIV testing, treatment, and care services. Horizons, the International Center for Research on Women (ICRW), and the Hanoi-based Institute for Social Development Studies (ISDS) tested the impact of two different interventions to reduce stigma and discrimination against patients living with HIV in the health care setting. This study drew on Horizons experience with a similar intervention study in hospitals in India, and ISDS and ICRW experience conducting stigma research and adapting intervention materials in Vietnam.

Stigma and discrimination are hypothesized to be caused mainly by a combination of (1) fear of contagion and infection through casual contact, and (2) social stigma manifested in blame, value judgments, and shame. This study tested the impact that additional activities to reduce social stigma have on activities to increase awareness of and reduce fear of contagion. Arm 1 of the intervention focused on fear reduction, improved awareness, and universal precautions, thereby addressing the first hypothesized cause of stigma. The other intervention arm (Arm 2) addressed both hypothesized main causes of stigma, and combined fear-reduction with social stigma-reduction activities (e.g., the participation of people living with HIV in group education sessions and the use of participatory, interactive exercises in the stigma reduction toolkit).

To measure impact, various factors were examined including: HIV transmission knowledge, attitudes toward patients living with HIV, discriminatory behaviors (e.g., refusal to treat patients living with HIV), and perceived stigma and discrimination (from the perspective of patients living with HIV). In each hospital selected for the study all health workers and a selection of patients living with HIV were surveyed before and after the intervention. In addition, qualitative data was gathered from a subsample of health care providers and patients living with HIV. Structured observations of practices and interactions also took place at the hospitals.

Key findings include:

At baseline, hospital workers reported high levels of both fear-based and value-based stigma.
Discriminatory behaviors and hospital practices were also common at baseline, and associated with fear-based stigma.
Lack of hospital policies fosters stigma and discrimination, which affects the quality of care.
Both interventions were successful in reducing both fear- and value-based stigma.
Both interventions were successful in reducing various discriminatory behaviors and hospital practices.
The impact of the Arm 2 intervention was greater than the Arm 1 intervention.
Key intervention elements included involving all cadres of staff in training and policy development, improving the structural environment, and involving HIV-positive individuals in staff training.

Location

Vietnam

Duration

December 2005–July 2007

Horizons and Population Council researchers

Julie Pulerwitz, Philip Guest, Jane Hughes

(For more information about this study, please contact horizons@popcouncil.org.)

Non-Council collaborators

Jessica Ogden, Laura Nyblade (International Center for Research on Women)

Khuat Thi Hai Oanh (Institute for Social Development Studies)

Haiphong TB and Pulmonary Hospital

Quang Ninh TB and Pulmonary Hospital

Donor

US Agency for International Development

Publications/Resources
Horizons and Population Council researchers' names appear in boldface type.

2008
Khuat Thi Hai Oanh, Kim Ashburn, Julie Pulerwitz, Jessica Ogden, and Laura Nyblade. “Improving hospital-based quality of care in Vietnam by reducing HIV-related stigma and discrimination,” Horizons Final Report. Washington, DC: Population Council. (PDF of full report; PDF of appendixes only)

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