Population Council Research that makes a difference

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.

Related projects

• Improving the Hospital Environment for HIV-positive Clients in India