Reducing HIV-related stigma and discrimination in Vietnamese hospitals

In Vietnam, HIV-related stigma and discrimination in the healthcare setting has been recognized as an important issue. This presentation describes the impact of interventions to reduce stigma in two Vietnamese hospitals. The study compared the impact of interventions that address two underlying causes of stigma: health worker's fear of contagion and negative value judgments toward people living with HIV. One hospital received a fear-reduction intervention and the other a combined intervention. Baseline and end-line survey data were collected among all hospital workers (n= 344 at baseline). Qualitative interviews with staff and HIV+ patients, and structured observations of hospital practices, were also conducted. Monitoring visits took place monthly to track changes. At baseline, hospital workers were largely fearful of patients with HIV due to misconceptions surrounding risks of contagion, and many reported blaming attitudes towards PLHA. This was accompanied by discriminatory behaviors such as patient isolation, labeling, and avoidance. The resulting interventions included training for hospital staff, developing hospital policies, and supporting the hospital to modify the structural environment. During the monitoring visits, various positive changes were observed in one or both hospitals (e.g. HIV+ patients in the hospital were no longer wearing specially marked clothes), and the combined intervention hospital demonstrated more changes. Lessons learned include that partnering with each hospital to design the intervention was key to building support, and that involving all categories of hospital staff (e.g., doctors, guards) in the training was important for promoting a stigma-free environment.