HIV-Related Stigma and Discrimination Among Health Care Workers During Early Program Decentralization in Indonesia: A Cross-Sectional Study

Abstract

Background Expanding HIV services by decentralizing provision to primary care raises a possible concern of HIV-related stigma and discrimination (SAD) from health care workers (HCWs) as new service points gain experience in HIV care delivery during early implementation. We surveyed indicators and examined the correlates of SAD among HCWs in a decentralizing district of rural Gunungkidul, Indonesia. Methods We conducted a cross-sectional survey on a random stratified sample of 234 HCWs in 14 public health facilities (one referent hospital, 13 primary health centers [PHC]) during the second year of decentralization roll-out in the district. We computed the prevalence of SAD indicators and used multivariable logistic regression with bootstrap standard errors to estimate the correlates of these indicators controlling for variations across facility units. Results The prevalence of SAD among HCWs was ~ 71% in fear of HIV transmission when caring for people living with HIV (PLHIV), ~ 75% in perceived negative image of PLHIV, and tended to differ between hospital and PHC HCWs for avoidance of service duties to HIV key populations (52.5% vs. 63.8%; p = 0.081) and discriminatory practices during HIV care delivery (96.1% vs. 85.2%; p = 0.008). Recent interactions with PLHIV and receipt of training lowered the odds of fear of HIV transmission (p ≤ 0.036). However, the odds of avoiding care duties increased with receipt of training (p < 0.001) and male sex (p = 0.050). Age, HIV knowledge, hospital facility, and non-physician cadres increased the odds of discriminatory practices (p ≤ 0.026). No significant correlate was found for perceived negative image of PLHIV. Conclusion HIV-related SAD among HCWs can be prevalent during early decentralization, highlighting the need for timely or preparatory interventions with a focus on building the capacity of hospital and non-physician workforce for positive patient-provider interactions when delivering HIV care.