Health-sector based stigma and discrimination: Evaluation of attitudes and practices of health care providers towards HIV-positive patients in Dar es Salaam, Tanzania

Background: HIV/AIDS-related stigma has been recognized as a great challenge to improving HIV/AIDS care around the world. Studies have suggested that provider stigma may be affecting the type of care delivered and patient decisions to seek health services in a timely manner. Methods: Interviews with 204 health personnel were conducted in three public hospitals in Dar es Salaam, Tanzania to evaluate the prevalence of stigma and discrimination towards patients living with HIV/AIDS (PLWHAs), factors associated with stigmatizing attitudes, and the relationship of stigma to the type of care provided. HIV/AIDS-related knowledge and fear of infection were also obtained. Results: Providers sampled were knowledgeable regarding HIV (mean score: 73%), but less informed on prevention strategies such as injection safety. 97% expressed at least one negative attitude towards PLWHAs, and 72% expressed fear of infection during casual contact. The most commonly reported discriminatory practices were selective use of universal precautions (35%), denial of services (12%), and substandard treatment (8%). Provider knowledge was protective against stigmatizing attitudes (b= -0.54, p<0.05), while fear increased the likelihood of expressed stigma (b= 3.02, p<0.05). Providers also with increased stigma were more likely to report self-enacted discriminatory practices (OR: 1.08, p<0.05) which was marginally associated with reports of peer-enacted discriminatory practices (OR: 2.17, p=0.05). Conclusion: These data highlight the important need for interventions such as non-discrimination policies, HIV/AIDS-related training in universal precautions and infection prevention, as well as improving communicative forums in the context of providing HIV services to address provider concerns and attitudes towards PLWHAs.