A pretest‐posttest design to assess the effectiveness of an intervention to reduce HIV‐related stigma and discrimination in healthcare settings in Vietnam

Abstract

Introduction Stigma and discrimination are important barriers to HIV epidemic control. We implemented a multi‐pronged facility‐level intervention to reduce stigma and discrimination at health facilities across three high‐burden provinces. Key components of the intervention included measurement of stigma, data review and use, participatory training of healthcare workers (HCWs), and engagement of people living with HIV and key populations in all stigma reduction activities. Methods From July 2018 to July 2019, we assessed HIV‐related stigma and discrimination among patients and HCWs at 10 facilities at baseline and 9 months following an intervention. A repeated measures design was used to assess the change in stigma and discrimination among HCWs and a repeated cross‐sectional design assessed the change in stigma and discrimination experienced by PLHIV. HCWs at target facilities were invited at random and PLHIV were recruited when presenting for care during the two assessment periods. McNemar's test was used to compare paired proportions among HCWs, and chi‐square test was used to compare proportions among PLHIV. Mixed models were used to compare outcomes before and after the intervention. Results Semi‐structured interviews were conducted with 649 and 652 PLHIV prior to and following the intervention, respectively. At baseline, over the previous 12 months, 21% reported experiencing discrimination, 16% reported self‐stigma, 14% reported HIV disclosure without consent and 7% had received discriminatory reproductive health advice. Nine months after the intervention, there was a decrease in reported stigma and discrimination across all domains to 15%, 11%, 7% and 3.5%, respectively (all p‐values <0.05). Among HCWs, 672 completed the pre‐ and post‐intervention assessment. At baseline, 81% reported fear of HIV infection, 69% reported using unnecessary precautions when caring for PLHIV, 44% reported having observed other staff discriminate against PLHIV, 54% reported negative attitudes towards PLHIV and 41% felt uncomfortable working with colleagues living with HIV. The proportions decreased after the intervention to 52%, 34%, 32%, 35% and 24%, respectively (all p‐values <0.05). Conclusions A multi‐pronged facility‐level intervention was successful at reducing healthcare‐associated HIV‐related stigma in Vietnam. The findings support the scale‐up of this intervention in Vietnam and highlight key components potentially applicable in other settings.

Public health services and intersectional stigma: a social sciences perspective with implications for HIV service design and delivery

“…A study by Pollack et al . [51 ▪▪ ] evaluated a multipronged facility-level intervention in Vietnam that trained healthcare workers and used participatory approaches was able to decrease healthcare-associated HIV stigma (including discrimination and self-stigma). A pilot pragmatic trial targeting intersectional stigma among pregnant women living with HIV in Botswana found that the intervention led to a reduction in HIV-related stigma among participants, highlighting the importance of interventions that address structural issues that shape the experiences of individuals with multiple marginalized identities [52].…”

Integrating PrEP in maternal and child health clinics in Kenya: analysis of a service availability and readiness assessment (SARA) survey

“…Without providing adequate privacy for HTS and PrEP delivery, it will be challenging to scale-up integration of PrEP in MCH in order to reach women with greatest need ( 46 , 47 ). In the literature, the majority of stigma-reduction interventions focus on reducing stigma among HCWs or reducing internalized stigma among people living with HIV; these methods include trainings for HCWs and popular opinion leaders, group education and trainings including people living with HIV, restructuring facility anti-discrimination policies, and rarely, social media campaigns ( 48 – 51 ). There is a need for stigma-reduction interventions that target people not living with HIV that will enable them to take full advantage of HIV prevention services.…”

Stigma and fear of getting sick in the care of people living with HIV: an exploratory systematic review

“…Healthcare professionals drew attention to the interconnected nature of public stigma, self-stigma, and a wide range of other challenges faced by PLWH that hinder access to healthcare services [32]. Pollack et al reported in their work that women living with HIV were more likely to report self-stigma (OR=1.85, 95% CI: 1.33-2.58) and to have experienced the disclosure of their serostatus by a healthcare professional without their consent (OR=1.60, 95% CI: 1.10-2.31) [40].…”