Assessing stigma among clinical staff new to HIV testing: IPPF's experience in the Caribbean

With the highest HIV prevalence rates outside of Sub-saharan Africa, itis urgent that HIV prevention efforts in the Caribbean address the factors that drive the progression of the epidemic, such as provider stigma. In 2006, International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) Member Associations in Jamaica, Haiti and Suriname that are in the process of integrating HIV testing into their sexual and reproductive health services have developed and implemented a tool which measures knowledge and attitudes toward HIV/AIDS in order to tailor training for their providers' needs.

The survey includes a 9-item attitude scale to measure stigma towards people living with HIV/AIDS (PLWHA). All clinic staff was surveyed, however sample size was small due to clinic size. The baseline analysis revealed gaps in knowledge and attitudes towards PLWHA, which proved useful in defining training and sensitization needs, as well as some regional trends. Endline data will be collected prior to November 2007.

Patient rights and confidentiality, stigmatizing attitudes, underlying provider concerns, and MTCT transmission were among the identified issues to target during staff training and sensitization. There were also trends reflecting higher stigmatizing attitudes, despite high levels of knowledge. This has indicated the need for trainings to focus sensitization as well as the need to follow up. The survey could be useful for other service-providing organizations or those interested in working around HIV/AIDS, to determine training needs. Additionally, certain survey indicators could be used as baseline and end-line measures to assess effectiveness of interventions.