Latar belakang: Tujuan dari penelitian ini untuk mengetahui tingkat stigma dan diskriminasi tenaga kesehatan terhadap orang dengan HIV/AIDS (ODHA) serta menentukan faktor yang mempengaruhinya.

c l i n i c a l e p i d e m i o l o g y a n d g l o b a l h e a l t h 3 (2 0 1 5) 2 9 e3 6

Background and Objectives: There is a limited evidentiary base on the development of family medicine in different contexts and countries. The lack of evidence impedes our ability to compare and characterize family medicine models and identify areas of success that have led to the effective provision of care. This paper offers a comparative compilation and analysis of the development of family medicine training programs in seven countries: Brazil, Canada, Ethiopia, Haiti, Indonesia, Kenya, and Mali. Methods: Using qualitative case studies, this paper examines the process of developing family medicine programs, including enabling strategies and barriers, and shared lessons. An appreciative inquiry framework and complex adaptive systems thinking inform our qualitative study. Results: Committed partnerships, the contribution of champions, health policy, and adaptability were identified as key enablers in all seven case studies. The case studies further reveal that some enablers were more salient in certain contexts as compared to others, and that it is the interaction of enablers that is crucial for understanding how and why initiatives succeeded. The barriers that emerged across the seven case studies include: (1) resistance from other medical specialties, (2) lack of resources and capabilities, (3) difficulty in sustaining support of champions, and (4) challenges in brokering effective partnerships. Conclusions: A key insight from this study is that the implementation of family medicine is nonlinear, dynamic, and complex. The findings of this comparative analysis offer insights and strategies that can inform the design and development of family medicine programs elsewhere.

Available online xxxKeywords: Stigmatized attitude Health care worker Health care setting Stigma PLHIV a b s t r a c t Introduction: Study of HIV-related stigmatized and discriminatory attitudes is predominantly conducted in the regions with high HIV prevalence; therefore, understanding about stigmatized and discriminatory attitudes dynamic in the region with a very low HIV prevalence is needed. Aim: To identify the levels of stigmatized attitudes toward people living with HIV (PLHIV)and their predictors among health care providers (HCPs) in Aceh, the lowest HIV prevalence province in Indonesia.Material and methods: A cross-sectional study was conducted in seven regencies in Aceh.Structured questionnaires were used to collect data from 589 HCPs (doctors, nurses, midwifes and supporting staffs). Univariate analyses including one-way analysis of variance, ttest and correlation test were performed according to data type. Multiple linear regression was conducted to identify the predictors of stigmatized attitudes. Results and discussion:The level of HIV-stigmatized attitudes among HCPs in Aceh was high.Univariate analysis revealed that location, experience of direct contact with PLHIV, knowledge on HIV transmission and prevention, value-driven stigma and overestimated risk to HIV transmission were associated significantly with stigmatized attitudes levels (P < 0.05).