Population Council Research that makes a difference

Stigma and discrimination are widespread problems for people living with HIV and AIDS, particularly in health care settings. Horizons, SHARAN, and the Institute of Economic Growth collaborated with the National AIDS Control Organization (NACO) in India and three New Delhi hospitals to design and assess responses to hospital-based stigma and discrimination; a pre-/post-test evaluation design was used to assess the outcomes.

Central to the design of each hospital’s response to AIDS-related stigma and discrimination was a self-assessment checklist. This tool identifies institutional strengths and weaknesses of services for people living with HIV, and of policies and procedures to prevent occupational exposure to HIV by staff.

Based on the checklist and findings from a baseline survey of doctors, nurses, and ward staff, action plans were developed to address program and policy gaps, which included developing and disseminating guidelines for HIV care and management, sensitization training of health workers about the needs and rights of people with HIV, and developing and disseminating educational material on infection control procedures and postexposure prophylaxis availability for staff.

The follow-up survey found an increase in knowledge about HIV transmission among health care workers. The study also found improvements in health workers’ attitudes toward people living with HIV, less support for discriminatory hospital practices, and positive changes in the use of infection control procedures and HIV testing and counseling procedures.

The results of the study galvanized the collaborating hospitals in New Delhi to scale up the intervention hospital-wide to all departments and staff. NACO endorsed the use of the checklist in all public hospitals and disseminated it to all the State AIDS Control Societies in the country. The study has received worldwide attention as one of the few hospital-based interventions to counter stigma and discrimination, including endorsement from UNAIDS and the International Council of Nurses. In addition, the intervention tools are being adapted for other countries’ use.

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Related project: Reducing HIV/AIDS-related Stigma and Discrimination in the Health Care Setting in Vietnam