Assessing HIV-related stigma and discrimination among HIV CT trainers and providers in the Caribbean

PURPOSE: HIV-related stigma and discrimination (S&D) is a significant barrier to HIV prevention, care, and treatment in the Caribbean. An assessment was conducted to measure HIV-related S&D among HIV counseling and testing (CT) trainers and providers in the Caribbean between July 2007 and January 2008.

METHODS: Study population was a convenience sample of a pool of 5,710 HIV CT trainers and providers trained by Jhpiego and the Caribbean HIV/AIDS Regional Training Network (CHART) since the HIV CT program's inception in 2001. Methods included a self-administered survey and focus group discussions (FGD). Bivariate analyses were conducted to measure associations using chi-square or Fisher exact tests. FGD transcriptions were analyzed using NVivo.

RESULTS: 279 respondents completed the survey and 13 FGDs were conducted in 5 Caribbean countries. Survey responses showed low levels of stigma. Reported fear of HIV transmission increased with more invasive procedures. FGDs revealed stigmatizing statements toward groups of people “likely to be infected with” or “spreading” HIV, and that fear of HIV transmission was due to lack of education. Data suggest that discrimination toward HIV positive people still exists in health facilities.

RECOMMENDATIONS: CHART recognizes the need for more discussion on S&D, and has integrated this component into trainings. Future programs should include more sessions on disease transmission, and include PLHIV to discuss their experiences with health providers. Health providers' attitude should be emphasized to help change behaviors. Institutional policies may assist in reducing S&D by reinforcing the importance of confidentiality in the health care setting and may help to reduce inadvertent disclosure.