154716 Reducing HIV-related stigma and discrimination in Vietnamese hospitals

Wednesday, November 7, 2007

Khuat Thi Hai Oanh, MD , Institute for Social Development Studies, Hanoi, Vietnam
Julie Pulerwitz, ScD , Horizons/Population Council (seconded from PATH), Washington, DC
Jessica Ogden, PhD , International Center for Research on Women, Washington, DC
Laura Nyblade, PhD , International Center for Research on Women, Washington, DC
Kim Ashburn, PhD , International Center for Research on Women, Washington, DC
Mr. Muc , Consultant, Washington, DC
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.

Learning Objectives:
(1) To identify key manifestations of stigma and discrimination in the healthcare setting in Vietnam (2) To describe an intervention developed in partnership with hospitals and various other groups and institutions (e.g. PLHA groups) to reduce hospital-based stigma and discrimination. (3) To describe results related to changes after the intervention.

Keywords: Health Care Quality, Partnerships

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.