Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran

Abstract

BackgroundPeople living with HIV (PLHIV) sometimes experience discrimination. There is little understanding of the causes, forms and consequences of this stigma in Islamic countries. This qualitative study explored perceptions and experiences of PLHIV regarding both the quality of healthcare and the attitudes and behaviours of their healthcare providers in the Islamic Republic of Iran.MethodsIn-depth, semi-structured interviews were held with a purposively selected group of 69 PLHIV recruited from two HIV care clinics in Tehran. Data were analyzed using the content analysis approach.Results and discussionNearly all participants reported experiencing stigma and discrimination by their healthcare providers in a variety of contexts. Participants perceived that their healthcare providers' fear of being infected with HIV, coupled with religious and negative value-based assumptions about PLHIV, led to high levels of stigma. Participants mentioned at least four major forms of stigma: (1) refusal of care; (2) sub-optimal care; (3) excessive precautions and physical distancing; and (4) humiliation and blaming. The participants' healthcare-seeking behavioural reactions to perceived stigma and discrimination included avoiding or delaying seeking care, not disclosing HIV status when seeking healthcare, and using spiritual healing. In addition, emotional responses to perceived acts of stigma included feeling undeserving of care, diminished motivation to stay healthy, feeling angry and vengeful, and experiencing emotional stress.ConclusionsWhile previous studies demonstrate that most Iranian healthcare providers report fairly positive attitudes towards PLHIV, our participants' experiences tell a different story. Therefore, it is imperative to engage both healthcare providers and PLHIV in designing interventions targeting stigma in healthcare settings. Additionally, specialized training programmes in universal precautions for health providers will lead to stigma reduction. National policies to strengthen medical training and to provide funding for stigma-reduction programming are strongly recommended. Investigating Islamic literature and instruction, as well as requesting official public statements from religious leaders regarding stigma and discrimination in healthcare settings, should be used in educational intervention programmes targeting healthcare providers. Finally, further studies are needed to investigate the role of the physician and religion in the local context.

The role of emotions in the reduction of HIV/AIDS stigma among physicians in training

“…For example, research documents how stigma can negatively influence the mental health of PLWHA, leading to depression, low self-esteem, and anxiety, among other effects (Li, Wang, Williams, & He, 2009; Rahmati-Najarkolaei et al, 2010; Whetten, Reif, Whetten, & Murphy-Mcmillan, 2008). Furthermore, HIV/AIDS stigma can also negatively affect physical health as it can limit access and adherence to antiretroviral treatment, which in turn accelerates disease progression and increases the risk of HIV transmission (Earnshaw, Smith, Chaudoir, Amico, & Copenhaver, 2013; Sayles, Wong, Kinsler, Martins, & Cunningham, 2009).…”

Attitude of Health Personnel Towards People Living With HIV

“…Başka bir çalışmada HIV hakkında geniş bilgi sahibi olma, etiketleme ve ayrımcılık konulu eğitimlere katılmış olma, yüksek eğitim düzeyine sahip olma ve dindar olmamanın etiketleme ve ayrımcılığı azalttığı gözlenmiştir (13). İran'da sağlık çalışanları üzerinde yapılan bir çalışma sonucunda, tıbbi eğitimin etiketlemeyi azaltıcı programları içerecek şekilde güçlendirilmesi, din liderlerinden etiketleme ve ayrımcılığı azaltmaya yönelik resmi bildiriler alınması önerilmiştir (14).…”

Patient and Provider Perspectives on HIV and HIV-Related Stigma in Dutch Health Care Settings

“…15,26 Perceived HIV-related stigma in health care can result in testing and treatment delays, avoidance of health services, and poorer quality care as a result of nondisclosure to health care providers. [30][31][32][33][34][35] In addition, perceived HIV-related stigma in health care settings can have detrimental psychological consequences, in part because perceived stigma, regardless of setting, negatively impacts psychological well-being, 14,36,37 but also because health care providers are what Goffman termed 'the wise'. 2 They are expected to have knowledge about HIV and to not discriminate against PLWH.…”

“…Unfortunately, previous research has shown that this is not always the case. [38][39][40] Research on the impact of HIV-related stigma in health care has shown that perceived stigmatization in health care settings is related to decreased patient satisfaction, psychological distress, low self-esteem, the feeling that one is undeserving of care, and diminished motivation to stay healthy, 14,31,41 while positive interactions between health care providers and PLWH have been found to contribute to better treatment adherence and health-related quality of life. [42][43][44][45] Clearly, ensuring that PLWH feel accepted and treated equally in health care settings is imperative.…”