Stigma and Discrimination Related to HIV in the Health Services Area 10, Thailand

Abstract

This research aimed to study stigma and discrimination related to HIV. Samples were recruited by sampling method among 958 health care providers and 872 people living with HIV from all hospitals in Health Service Area 10, including Ubon Ratchathani, Sisaket, Yasothon, Amnat Charoen and Mukdahan during March-June, 2017. Data collection tools included a self-administered questionnaire and an interview form about stigma and discrimination developed by Department of Disease Control, Ministry of Public Health. The results were analyzed by the REDCap-data import tool and statistically analyzing by odds ratio and correlation. The study found that 83.39% of healthcare providers had at least one negative attitude towards people living with HIV, such as believing they were irresponsible or exhibiting inappropriate behavior (54.94%). More specifically, 51.78% disagreed with HIV-positive women who wanted to have children, while 50.66% were worried about exposing themselves to HIV while providing care. Additionally, 35.17% felt awkward working with HIV-positive staff or personnel. Discrimination was also prevalent, with 57.17% of healthcare providers overprotecting themselves during service delivery and 26.91% demonstrating at least one discriminatory behavior, such as being reluctant to serve certain key populations (23.05%). Among people living with HIV, 15.02% reported experiencing discrimination while receiving health services. Self-stigmatization was also common, with 34.86% of respondents feeling ashamed of their status and 30.04% deciding to avoid hospital visits due to feelings of guilt. Embarrassment was also a factor, with 15.25% of respondents feeling ashamed of their HIV-positive status. The study also found that healthcare professionals were more willing to provide care services to key populations than non-professionals (OR=0.54; 95%CI 0.36-0.79) and were more concerned about HIV transmission through contact with clients' personal items (OR=1.74; 95%CI 1.24-2.44), but less likely to use double gloves for self-protection (OR=2.87; 95%CI1.90-4.33). Moreover, primary populations were more likely to experience stigma and discrimination in healthcare settings than the general population (OR=2.08; 95%CI 1.15-3.77). Those who had known about their HIV-positive status for more than 10 years were also more likely to experience discrimination than those who had known for less than 10 years (OR=1.79; 95%CI 1.07-3.02). Lastly, those who had been stigmatized and advised by healthcare providers to abstain from having children were significantly higher in the group of people who had known about their HIV-positive status for more than 10 years (OR=1.45; 95%CI 1.07-1.98). Recommendations: Health care facilities should establish a standardized approach to providing quality services that prioritize the confidentiality of healthcare providers while also being friendly, secure, compassionate, and respectful of human rights and dignity of clients. Such an approach would encourage clients to receive healthcare services continuously, leading to a reduction in new HIV cases and contributing to the goal of ending AIDS by 2030.