Correlates of observing and willingness to report stigma towards HIV clients by (TB) health workers in Africa

M. Straetemans, M. I. Bakker, E. M. H. Mitchell

Research output: Contribution to journalA1: Web of Science-article

Abstract

SETTING: Health care facilities in Kenya, Tanzania and Namibia.

OBJECTIVE: To study the factors associated with the observation of and willingness to report stigmatising behaviour towards persons living with the human immunodeficiency virus (HIV) among health care workers (HCWs).

DESIGN: Mixed-effect logistic regression analyses of 9516 HCW interviews, including those of 4062 (43%) TB workers carried out as part of the Service Provision Assessments (SPAs) between 2006 and 2010.

RESULT: Discrimination (i.e., enacted stigma) was observed by respectively 1042 (60%), 384 (40%) and 907 (69%) TB workers in Kenya, Namibia and Tanzania, similar to the trend observed among all HCWs. Observations of discrimination were clustered at facility level in Kenya, and mapping of facility-level discrimination suggested geographic clustering. HCWs were more likely to observe discrimination in facilities without regular supportive supervision (adjusted OR [aOR] 2.33, 95%CI 1.09-4.96). No HCW characteristics were found to predict intention to report. Training in patients' rights and in confidentiality predisposed HCWs to recognise discrimination (aOR 2.51, 95%CI 1.19-5.28) and the willingness to report it (aOR 2.23, 95%CI 1.11-4.47). Exposure to training in TB infection control (IC) was associated with greater willingness to report discrimination (aOR 2.13, 95%CI 1.03-4.39).

CONCLUSION: Supervision and exposure to training in patient's rights and confidentiality improved HCWs' understanding and advocacy of dignified and respectful TB-HIV care. All HCWs are equally likely to be allies, agents of change and amplifiers of an anti-stigma message, and broad engagement is required. Innovative approaches to reduce discrimination-while ensuring proper IC-should be explored.

Original languageEnglish
JournalInternational Journal of Tuberculosis and Lung Disease
Volume21
Issue number11
Pages (from-to)S6-S18
Number of pages13
ISSN1027-3719
DOIs
Publication statusPublished - 2017
Externally publishedYes

Keywords

  • discrimination
  • infection control
  • Kenya
  • Tanzania
  • Namibia
  • FREE STATE PROVINCE
  • SUB-SAHARAN AFRICA
  • TUBERCULOSIS STIGMA
  • URBAN DISTRICT
  • CARE WORKERS
  • SCALE-UP
  • INTERVENTION
  • TRANSMISSION
  • MANAGEMENT
  • PEOPLE

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