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HIV Stigma Index among  Healthcare Workers
General Objective• To ascertain the HIV knowledge, attitudes and  level of stigma & discrimination towards  people living ...
Specific Objective1. To assess the level of stigma among healthcare   providers towards PLHIV2. To describe the knowledge ...
Study SettingNational Hospital of Sri Lanka   De Soysa Maternity Hospital     Lady Ridgeway Hospital for Children  Castle ...
Study Design      • Cross sectional study        design
Sampling technique and sample sizeInstitutions:    1. NHSL, 2. DMH, 3. CSHW, 4. LRH, 5.       • Quota sampling was done   ...
Ethical considerations        • Informed consent        • Voluntary          participation/Autonomy        • Confidentiali...
RESULTS
Age distribution Mean age of the sample was 41 years (SD, 10.6 years) Range 38-41.7 yearsCategory of staff     Mean age   ...
Distribution of the sample by category of staff Over half of the sample is represented by the Nursing staff (24.6%) and ho...
Experience as a healthcare workerAverage years of experience was 15 years  Category of staff   Mean years   Standard Devia...
Provision of care to an HIV patient                   Have you ever provided care to an HIV patient          100          ...
Cause of Stigma & DiscriminationFear of HIV transmission by type of contact     with people living with HIV/AIDS
Fear of HIV transmission by type of contact                  Labourers      Attendants          MLTs        Nurses     Doc...
Fear of HIV transmission by type of contact     Giving injec/drip     Dressing wounds            Touching saliva     Touch...
Cause of Stigma & DiscriminationMorality related attitudes towards              PLHIV
Morality Related Attitudes towards PLHIV                              Labourers              Attendants              MLTs ...
Enacted Stigma (Discrimination)
In the past 12 months have you seen the following happen in your health facility              because a client was known t...
Stigma Index(21-Item Stigma Index)
21-Item Stigma index• Twenty-one item stigma Index used in this study to measure the level of  HIV stigma among healthcare...
HIV Stigma Index among Healthcare workersStigma Index by category of staff                                                ...
HIV/AIDS Knowledge among    Healthcare Workers
Knowledge on HIV transmission                             Labourers             Attendants         MLTs      Nurses      D...
Occupational exposure to bloodPrevalence of percutaneous injuries and splashes
Prevalence of percutaneous injuries or splashes                         Labourers             Attendants     MLTs       Nu...
Knowledge on post-exposure      management
Knowledge on post-exposure management of                     needle prick injuries                             Labourers  ...
Under what circumstances should a healthcare                        worker seek PEP                         Labourers   At...
What should be done to prevent HIVtransmission to Healthcare workers
In your opinion, what should be done to prevent HIV                  transmission to HCWs in hospital setting             ...
Conclusions and Recommendations (1 of 5)• Results showed that about 23%-38% stigma level  among healthcare workers• Prevai...
Conclusions and Recommendations (2 of 5)• Fear of HIV transmission is one of the reasons for  stigmatizing patients with H...
Conclusions and Recommendations (3 of 5)• It is difficult to expect respectful, stigma free  behaviours among HCWs unless ...
Conclusions and Recommendations (4 of 5)• Healthcare providers are not free of  misperceptions, misconceptions and  judgem...
Conclusions and Recommendations (5 of 5)Healthcare providers should have their own rights to be protected from HIV and way...
Sponsors
AcknowledgementPrincipal Investigator: Dr. D Ajith KarawitaCo-investigators: Dr. KAM Ariyaratne, Dr. Manoji GunathilakeCon...
HIV stigma index among healthcare workers, Sri Lanka
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HIV stigma index among healthcare workers, Sri Lanka

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Results of a study on HIV stigma among healthcare workers, Sri Lanka

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Transcript of "HIV stigma index among healthcare workers, Sri Lanka"

  1. 1. HIV Stigma Index among Healthcare Workers
  2. 2. General Objective• To ascertain the HIV knowledge, attitudes and level of stigma & discrimination towards people living with HIV among healthcare workers, in selected healthcare settings in Colombo.
  3. 3. Specific Objective1. To assess the level of stigma among healthcare providers towards PLHIV2. To describe the knowledge and general attitudes towards PLHIV3. To describe the knowledge and practices related to standard precaution
  4. 4. Study SettingNational Hospital of Sri Lanka De Soysa Maternity Hospital Lady Ridgeway Hospital for Children Castle Street Hospital for Women National STD/AIDS Control Programme Hospital, Angoda Base
  5. 5. Study Design • Cross sectional study design
  6. 6. Sampling technique and sample sizeInstitutions: 1. NHSL, 2. DMH, 3. CSHW, 4. LRH, 5. • Quota sampling was done CSTDC, 6. BH(Angoda) considering the relativeCategory of staff: 1. DOCs, 2. NOs, 3. MLTs, 4. ATs, 5. LAs proportions of healthcare workers. Estimated Population: 5898 Category Sample size Doctors 130 Nursing officers 205 MLTs 92 Attendants 154 Labourers 251 Total 832 Sample: 832 (14.1%)
  7. 7. Ethical considerations • Informed consent • Voluntary participation/Autonomy • Confidentiality • Data security • Ethical clearance was taken from the ethics committee of the faculty of Medicine, University of Peradeniya
  8. 8. RESULTS
  9. 9. Age distribution Mean age of the sample was 41 years (SD, 10.6 years) Range 38-41.7 yearsCategory of staff Mean age N SDDoctors 41.73 130 9.737Nursing staff 39.93 205 10.559MLTs 38.51 91 9.744Attendants 48.35 147 6.150Labourers 38.06 246 11.454Total 41.01 819 10.612
  10. 10. Distribution of the sample by category of staff Over half of the sample is represented by the Nursing staff (24.6%) and hospital labourers (30.2%)Category of staff Frequency Percent Cumulative PercentDoctors 130 15.6 15.6Nursing staff 205 24.6 40.3MLTs 92 11.1 51.3Attendants 154 18.5 69.8Labourers 251 30.2 100.0Total 832 100.0
  11. 11. Experience as a healthcare workerAverage years of experience was 15 years Category of staff Mean years Standard Deviation (Months) Doctors 13.10 9.7069 Nursing staff 15.70 10.9271 MLTs 13.13 10.0739 Attendants 22.67 6.1455 Labourers 11.06 9.0230 Total 14.90 10.1572
  12. 12. Provision of care to an HIV patient Have you ever provided care to an HIV patient 100 90 85.9 80 Yes No Dont know 70 66.7 67.8 60.9 60Percent 49.8 50 43.3 40 30.5 30 18.6 18.5 20 14.7 13.7 10.9 8.6 10 6.9 3.3 0 Doctors Nursers MLTs (N=92) Attendants Labourers (N=129) (N=205) (N=151) (N=245)
  13. 13. Cause of Stigma & DiscriminationFear of HIV transmission by type of contact with people living with HIV/AIDS
  14. 14. Fear of HIV transmission by type of contact Labourers Attendants MLTs Nurses Doctors Giving inj/drip 34.1 53.5 72.7Dressing 62.3wounds 41 60.8 32.7Touching 28.5 40 saliva 23.4 35.4 12Touching 11.7 14.3 sweat 4.9 6.2 0 10 20 30 40 50 60 70 80 Percent
  15. 15. Fear of HIV transmission by type of contact Giving injec/drip Dressing wounds Touching saliva Touching sweat Labourers 72.7 32.7 12Attendants 62.3 28.5 11.7 MLTs 40 14.3 34.1 Nurses 41 23.4 4.9 53.5 Doctors 60.8 35.4 6.2 0 20 40 60 80 Percent
  16. 16. Cause of Stigma & DiscriminationMorality related attitudes towards PLHIV
  17. 17. Morality Related Attitudes towards PLHIV Labourers Attendants MLTs Nurses DoctorsI feel ashamed if someone in my family 69.7 72.7 44 infected 35.1 44.2 74.5 79.2 I feel ashamed if I was infected 50.5 47.3 55.4 30.8 45.8 It is the FSWs who spread the disease 33 23.4 40 Promiscuous men are the once that 62.4 70.8 58.9 spread the disease 52.2 55 51 61.2 Ashamed of themselves 13.2 5.4 6.2 66.9 69.9 Punishment for bad behaviours 35.2 26.3 16.2 11.6 13 Karume/punishment from God 11 2 6.2 0 20 40 60 80 100 Percent
  18. 18. Enacted Stigma (Discrimination)
  19. 19. In the past 12 months have you seen the following happen in your health facility because a client was known to have or was suspected of having HIV/AIDS Labourers Attendants MLTs Nurses DoctorsHCWs gossiping about the patients HIV 10.1 6.5 46.2 status 27.3 41.5 Testing the patient without patients 31.1 36.8 18.9 consent 29.8 22.3 22.8 Pass on the patient to to others 22.9 15.4 10.2 18.5 Use of latex gloves unnecessarily for 27.1 32 29.7 performing external examinations 30.7 30Requiring some patients to be tested for 63.7 64.7 63.7 HIV before scheduling surgeries 66.3 56.2 Extra precausions being takenin the 73.6 82.2 67sterilization of instruments used for HIV… 74.6 57.7Receiving less care/attention than other 12.4 11.7 11 patients 12.2 13.1 0 20 40 60 80 100 Percent
  20. 20. Stigma Index(21-Item Stigma Index)
  21. 21. 21-Item Stigma index• Twenty-one item stigma Index used in this study to measure the level of HIV stigma among healthcare workers.• Scoring was done on a three-point Likert scale (agree, can’t say, disagree) ranging from 1 to 3 with the score of 21 as minimum and 63 as the maximum score• The scoring was done according to the responses on the statements in the 21-item stigma scale. Stigmatizing Non Stigmatizing statement statement Agree 3 1 Disagree 1 3 Cant say 2 2• Higher score on the index denotes a higher level of stigma
  22. 22. HIV Stigma Index among Healthcare workersStigma Index by category of staff Stigma Scale (22-63) Laboures, 36.9 Attendants, 37.3 MLTs, 37.1 Nursing Officers, 31.6 Doctors, 33.4 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 Stigma Scale (21-63)
  23. 23. HIV/AIDS Knowledge among Healthcare Workers
  24. 24. Knowledge on HIV transmission Labourers Attendants MLTs Nurses Doctors 4.8Can a person get HIV by sharing a meal with 2.6 0 someone who infected 2 4.6 16 Can a person get HIV infection from 7.8 3.3 mosquito bites 3.4 3.8 73.3 Can a healthy looking person have HIV 78.6 91.2 infection 93.7 98.5 88 Can the risk of HIV be reduced by using 92.9 92.3 condoms 92.6 94.6 92Can the risk of HIV be reduced by having sex 93.5 97.8 with only one faithful, uninfected partner 94.1 94.6 0 20 40 60 80 100 Percent
  25. 25. Occupational exposure to bloodPrevalence of percutaneous injuries and splashes
  26. 26. Prevalence of percutaneous injuries or splashes Labourers Attendants MLTs Nurses Doctors 2.4blood splashes on 2.6 15.4mm/non-intact skin 12.2 11.5 cut with a sharp 0.8 instrument 2.6 13.2(Contaminated with 3.4 blood) 8.5 2.4 Needle pricks 3.2(Contaminated with 9.9 blood) 14.1 23.1 0 20 40 60 80 100 Percent
  27. 27. Knowledge on post-exposure management
  28. 28. Knowledge on post-exposure management of needle prick injuries Labourers Attendants MLTs Nurses Doctors Report to infection 79.3 81.2 82.4 control staff 92.2 80 58.2 59.7 Report to head 67 79 52.3 13.5 11 Dress the wound 9.9 23.9 13.1 35.1 44.8Squeeze/Bleed wounds 63.7 62.9 32 Clean wound with 49 40.9 61.5 sntiseptics 56.1 59.2 Wash with soap and 49.4 57.1 69.2 water 89.3 70.8 0 20 40 60 80 100 Percent
  29. 29. Under what circumstances should a healthcare worker seek PEP Labourers Attendants MLTs Nurses Doctors 21.1HIV positive blood contact 26.6 33 with intact skin 22.9 22.5 48.6 Any blood contact with 51.9 52.7 non-intact skin 61.5 51.9 47.4 Any blood contact with 52.6 57.1 mucous membranes 55.1 56.6 71.6Needle stic injury from an 77.3 90.1 HIV patient 89.8 90.7 45 47.4 Any needle stick injury 46.2 48.8 33.3 0 20 40 60 80 100 Percent
  30. 30. What should be done to prevent HIVtransmission to Healthcare workers
  31. 31. In your opinion, what should be done to prevent HIV transmission to HCWs in hospital setting Labourers Attendants MLTs Nurses Doctors HIV patients should have a separate 27.5 23.4 22 26.2 40.7 healthcare institution Assume that every pt has HIV and always 63.3 63.6 90.196.1 take precausions 77.7 2.4 1.9 Do not accept HIV pts to hospitals 1 4.4 4.6 15.9 18.8 Supply enough PEP 45.4 53.8 64.6 Inform all hospital workers about HIV pts 34.440.2 31.9 21.527.8 30.7 40.3 Have enough clean running water to wash 54.9 62.4 55.4Wear special protections when touching HIV 57 65.9 74 pts 64.6 71.2 20.7 24 Test every patient for HIV 18 24.2 7.7 35.1 42.9 Supply enough gloves 66.3 73.178 0 20 40 60 80 100 Percent
  32. 32. Conclusions and Recommendations (1 of 5)• Results showed that about 23%-38% stigma level among healthcare workers• Prevailing level of HIV stigma and discrimination among HCWs is a reflection of the situation in the society. Therefore, fighting against HIV stigma and discrimination should not be confined to healthcare settings. It should be a broad approach which should include PLHIV, healthcare workers and general population as whole.
  33. 33. Conclusions and Recommendations (2 of 5)• Fear of HIV transmission is one of the reasons for stigmatizing patients with HIV. It has been observed to be prevalent among all the categories of staff.• Morality related attitudes are not uncommon among HCWs which is also a cause of stigma• stigma cannot be eliminated, but discriminatory actions can be eliminated within the healthcare settings (Target - zero discrimination by 2015)
  34. 34. Conclusions and Recommendations (3 of 5)• It is difficult to expect respectful, stigma free behaviours among HCWs unless they are specially trained to deal with an HIV positive patients• Most of the time doctors are missing in lot of training interventions. This study showed the importance of inclusion of all the categories of staff for better results• Although HCWs have the responsibility to adhere to standard precautions and equal rights for treatment care and support, decision makers in the healthcare system should also have the responsibility to make prevention supplies and PEP available.
  35. 35. Conclusions and Recommendations (4 of 5)• Healthcare providers are not free of misperceptions, misconceptions and judgemental attitudes towards PLHIV which persist in society at large, and need to be addressed
  36. 36. Conclusions and Recommendations (5 of 5)Healthcare providers should have their own rights to be protected from HIV and ways of upholding their rights BUT without denying the rights of PLHIV
  37. 37. Sponsors
  38. 38. AcknowledgementPrincipal Investigator: Dr. D Ajith KarawitaCo-investigators: Dr. KAM Ariyaratne, Dr. Manoji GunathilakeContributors Prof. A Pathmeswaran, Dr. Sujatha Samarakoon, Dr. S. Benaragama, , Dr. Sunera Fernando, Mr Hans Billimoria, Mrs Sherine Rodrigo UN Agencies: Dr. Indira hettiarachchi, Ms. Swairee Rupasinghe, Dr. Dayanath Ranatunge AIDS Foundation of Lanka: Dr. Palitha Abeykoon, Dr. Sarojini Perera We would like to acknowledge the support extended by the National STD/AIDS Control Programme, National Hospital of Sri Lanka (NHSL), De Soysa Maternity Hospital (DMH), Lady Ridgeway Hospital for Children (LRH), Castle Street Hospital for Women (CSHW) and Base Hospital Angoda (Infectious Disease Hospital) Most importantly we, would like to thank all the healthcare workers who participated in the research Dr. Darshani Wijewickrama and Dr Sathya Herath for translations Ms Nimali Magammana, Sister Chandrani Kumari Rajakarune, Nalaka Gamage, RW Bandara, Ms. Wasanthi Rajapakse, Ms. Anoma for data collection and data entry.
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