Reducing AIDS-related stigma and discrimination in Indian hospitals

People living with HIV/AIDS in India, as elsewhere, face stigma and discrimination in a variety of contexts. Research in India has shown that stigma and discrimination against HIV-positive people and those perceived to be infected are common in hospitals and act as barriers to seeking and receiving critical treatment and care services. Recognizing the need to move beyond documentation of the problem, three New Delhi hospitals; SHARAN, an Indian NGO; and the Horizons program, with support from the National AIDS Control Organisation (NACO), carried out an operations research project to develop and test responses to hospital-based stigma and discrimination against people living with HIV/AIDS. This report presents the findings which noted that despite variation among the hospitals in their action plan accomplishments, overall the intervention process was associated with improvements among healthcare workers in HIV knowledge, attitudes toward people living with HIV/AIDS, and certain practices with respect to HIV counseling and testing and confidentiality

Continuum of care for HIV-positive women accessing programs to prevent parent-to-child transmission: Findings from India

This study examined the efforts of PPTCT programs in different cities in India to offer women a continuum of care, and shows that the programs have both strengths and shortcomings. The government launched a national treatment program that offers antiretroviral therapy (ART) to HIV-positive women, children below 15 years of age, and men. However, since the start-up of the ART program there have been concerns about limited access to and utilization of these services by women and children. To address these shortcomings, the PPTCT programs studied should strengthen their referral systems to public and private treatment and family planning services, better equip PPTCT providers to inform and counsel women about these topics, and engage NGOs in the community that have outreach services to maintain contact with women over time and link them and their families to a continuum of care

Reducing stigma and discrimination in hospitals: Positive findings from India

People living with HIV (PLHIV) in India face stigma and discrimination in a variety of contexts. Stigma and discrimination against HIV-positive people is common in hospitals and acts as a barrier to seeking and receiving critical treatment and care services. Three New Delhi hospitals, SHARAN, and the Horizons Program collaborated on an operations research project to assess responses to hospital-based stigma and discrimination against PLHIV. A baseline survey to measure HIV/AIDS-related attitudes, knowledge, and practices was conducted in 2000 with a random sample of 884 health workers from four departments: medicine, STD and skin, obstetrics and gynecology, and surgery. Based on this assessment, hospital managers and senior representatives of doctors, nurses, and ward staff developed action plans to improve the situation. As noted in this research summary, hospital managers who used a checklist to assess their facilities’ policies and practices took action to improve staff safety and reduce AIDS-related stigma. Findings suggest that the actions taken, including education, training, policy formulation, and involvement of AIDS NGOs, contributed to improved knowledge, attitudes, and practices among health workers

Understanding and measuring AIDS-related stigma in health care settings: A developing country perspective

AIDS-related stigma and discrimination remain pervasive problems in health care institutions worldwide. This paper reports on stigma-related baseline findings from a study in New Delhi, India to evaluate the impact of a stigma-reduction intervention in three large hospitals. Data were collected via in-depth interviews with hospital staff and HIV-infected patients, surveys with hospital workers (884 doctors, nurses and ward staff) and observations of hospital practices. Interview findings highlighted drivers and manifestations of stigma that are important to address, and that are likely to have wider relevance for other developing country health care settings. These clustered around attitudes towards hospital practices, such as informing family members of a patient’s HIV status without his/her consent, burning the linen of HIV-infected patients, charging HIV-infected patients for the cost of infection control supplies, and the use of gloves only with HIV-infected patients. These findings informed the development and evaluation of a culturally appropriate index to measure stigma in this setting. Baseline findings indicate that the stigma index is sufficiently reliable (alpha = 0.74). Higher scores on the stigma index—which focuses on attitudes towards HIV-infected persons—were associated with incorrect knowledge about HIV transmission and discriminatory practices. Stigma scores also varied by type of health care providers—physicians reported the least stigmatising attitudes as compared to nursing and ward staff in the hospitals. The study findings highlight issues particular to the health care sector in limited-resource settings. To be successful, stigma-reduction interventions, and the measures used to assess changes, need to take into account the sociocultural and economic context within which stigma occurs