Stigma in health facilities: why it matters and how we can change it

Abstract

Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge—both approaches and methods—regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development’s Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described. The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.

How Do We Balance Tensions Between COVID-19 Public Health Responses and Stigma Mitigation? Learning from HIV Research

“…Stigma-reduction strategies for HIV and other health issues have largely targeted intrapersonal and interpersonal dimensions, far fewer have addressed structural factors such as legal issues, policies, and rights [36]. Interventions should address both drivers (knowledge, misinformation) and facilitators (health policies, institutional practices) [37]. We know from an extensive body of HIV-related stigma research that multiple stigma dimensions can negatively impact health practices and outcomes [5].…”

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

“…The prevalence [37‐39], forms [38‐43] and consequences [4,7‐9,12‐13,33] of health facility HIV stigma are well documented across the globe, as are key drivers of that stigma, including fear of contracting HIV in the workplace, lack of awareness and understanding of stigma, attitudes and the health facility institutional environment [4,37,40‐41,44‐49]. Yet despite this evidence and global recognition of the need to tackle stigma – especially in health facilities – there is little concrete evidence of concerted efforts by countries and donors to scale‐up stigma‐reduction interventions in health facilities within national HIV responses.…”

Lessons learned from HIV can inform our approach to COVID‐19 stigma

“…Such COVID‐19 stigma resistance tactics have already emerged, evidenced with the Twitter hashtags #IamNotaVirus, #NoSoyUnVirus and #JeNeSuisPasUnVirus. There is a rich evidence‐base of HIV‐related stigma interventions for healthcare providers that provide HIV information, share how stigma affects communities, encourage reflection on personal biases and ensure institutional support for stigma mitigation [13,26,27]. Other strategies include participatory learning through engaging activities such as discussions, games and role‐play [26,27].…”

“…The contact approach involves people who have experienced the stigma being targeted (e.g. persons living with HIV, persons experiencing COVID‐19 stigma) delivering the intervention to provide a face to the pandemic that in turn can foster empathy and reduce othering [26,27].…”