HIV-related stigma and discrimination in the New Zealand healthcare setting: a mixed-methods study
Susan Mundt A C and Simon Briggs BA Community HIV Team, Infectious Diseases Department, Auckland City Hospital, Private Bag 92024, Auckland Mail Centre, Auckland 1142, New Zealand.
B Infectious Diseases Department, Auckland City Hospital, Private Bag 92024, Auckland Mail Centre, Auckland 1142, New Zealand.
C Corresponding author. Email: s_mundt@hotmail.com
Sexual Health 13(6) 582-588 https://doi.org/10.1071/SH16063
Submitted: 14 April 2016 Accepted: 29 July 2016 Published: 23 September 2016
Abstract
Background: People living with HIV (PLHIV) assume that healthcare workers have an adequate knowledge of HIV and expect that they will be treated with respect and compassion in the healthcare setting. Despite the remarkable advances in HIV treatment in the past two decades, PLHIV have continued to experience HIV-related stigma and discrimination by healthcare workers worldwide. The aim of this study was to explore the prevalence and nature of stigma and discrimination experienced by PLHIV in the healthcare setting in New Zealand. Methods: This study involved a mixed-methods approach, using a questionnaire to collect quantitative and qualitative data from PLHIV recruited from the HIV Clinic at Auckland City Hospital and from two national HIV peer-support organisations between August 2012 and February 2013. Results: Two hundred and thirteen PLHIV participated in the study. One hundred PLHIV (47%) reported that they had ever experienced HIV-related discrimination by a healthcare worker. The types of discrimination included confidentiality problems (19%), additional infection control measures (19%) and rudeness (18%). Healthcare settings where most of the discrimination had been experienced were other (non-infectious diseases) hospital wards, dental clinics, other (non-HIV) outpatient clinics and general practice clinics. Conclusion: Almost half of the PLHIV in New Zealand have experienced stigma and discrimination in a healthcare setting. The findings of this study show that there is a need to continue to normalise the care of HIV and increase HIV education for healthcare workers.
Additional keywords: healthcare worker, HIV discrimination, HIV stigma, PLHIV.
References
[1] Goffman E. Stigma: notes on the management of spoiled identity. First Touchstone edn. New York: Simon and Schuster; 1986.[2] Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med 2003; 57 13–24.
| HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action.Crossref | GoogleScholarGoogle Scholar | 12753813PubMed |
[3] Madru N. Stigma and HIV: does the social response affect the natural course of the epidemic? J Assoc Nurses AIDS Care 2003; 14 39–48.
| Stigma and HIV: does the social response affect the natural course of the epidemic?Crossref | GoogleScholarGoogle Scholar | 14571685PubMed |
[4] Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol 2001; 27 363–85.
| Conceptualizing stigma.Crossref | GoogleScholarGoogle Scholar |
[5] Sayce L. Stigma, discrimination and social exclusion: what’s in a word? J Ment Health 1998; 7 331–43.
| Stigma, discrimination and social exclusion: what’s in a word?Crossref | GoogleScholarGoogle Scholar |
[6] Anderson B. HIV stigma and discrimination persist, even in health care. Virtual Mentor 2009; 11 998–1001.
| HIV stigma and discrimination persist, even in health care.Crossref | GoogleScholarGoogle Scholar | 23207098PubMed |
[7] Vanable P, Carey M, Blair D, Littlewood R. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav 2006; 10 473–82.
| Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women.Crossref | GoogleScholarGoogle Scholar | 16604295PubMed |
[8] Whetten K, Reif S, Whetten R, Murphy-McMillan L. Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care. Psychosom Med 2008; 70 531–8.
| Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care.Crossref | GoogleScholarGoogle Scholar | 18541904PubMed |
[9] UNAIDS. HIV-related stigma, discrimination and human rights violations: Case studies of successful programmes. Geneva: UNAIDS; 2005. Available online at: http://data.unaids.org/publications/irc-pub06/jc999-humrightsviol_en.pdf [verified 16 August 2016].
[10] Australasian Society for HIV Medicine. Stigma and discrimination around HIV and HCV in healthcare settings: Research report. Australasian Society for HIV Medicine; 2012. Available online at: http://www.ashm.org.au/resources/Pages/1976963391.aspx [verified 16 August 2016].
[11] Fair C, Ginsburg B. HIV-related stigma, discrimination, and knowledge of legal rights among infected adults. Journal of HIV/AIDS & Social Services 2010; 9 77–89.
| HIV-related stigma, discrimination, and knowledge of legal rights among infected adults.Crossref | GoogleScholarGoogle Scholar |
[12] Naughton J, Vanable P. HIV stigmatization among healthcare providers: review of the evidence and implications for HIV care. In Liamputtong P, editor. Stigma, discrimination and living with HIV/AIDS: a cross-cultural perspective. Bundoora: Springer; 2013. pp. 97–114.
[13] Zukoski A, Thorburn S. Experiences of stigma and discrimination among adults living with HIV in a low HIV-prevalence context: a qualitative analysis. AIDS Patient Care STDS 2009; 23 267–76.
| Experiences of stigma and discrimination among adults living with HIV in a low HIV-prevalence context: a qualitative analysis.Crossref | GoogleScholarGoogle Scholar | 19260770PubMed |
[14] Sayles J, Ryan G, Silver J, Sarkisian C, Cunningham W. Experiences of social stigma and implications for healthcare among a diverse population of HIV positive adults. J Urban Health 2007; 84 814–28.
| Experiences of social stigma and implications for healthcare among a diverse population of HIV positive adults.Crossref | GoogleScholarGoogle Scholar | 17786561PubMed |
[15] Power L, Bell M, Freemantle I. A national study of aging and HIV (50 plus). 2010. Available online at: http://www.jrf.org.uk/sites/files/jrf/living-with-HIV-full.pdf [verified 16 August 2016].
[16] Grierson J, Pitts M, Whyte M, Misson S, Hughes A, Saxton P, Thomas M. Living with HIV in New Zealand: balancing health and quality of life. N Z Med J 2004; 117 U1017
| 15475987PubMed |
[17] Grierson J, Thorpe R, Pitts M, Hughes T, Saxton P, Smith J, Smythe E, Thomas M. HIV futures New Zealand 2, monograph series number 66. Melbourne: The Australian Research Centre in Sex, Health and Society, Latrobe University; 2008.
[18] Ministry of Health. Country progress report: New Zealand (HIV/AIDS) 2012–13. Wellington: Ministry of Health; 2014. Available online at: http://www.health.govt.nz/publication/country-progress-report-new-zealand-hiv-aids-2012-13 [verified 16 August 2016].
[19] Grierson J, Pitts M, Koelmeyer R. HIV Futures Seven: the health and wellbeing of HIV positive people in Australia, monograph series number 88. Melbourne: The Australian Research Centre in Sex, Health and Society, Latrobe University; 2013.
[20] Weatherburn P, Keogh P, Reid D, Dodds C, Bourne A, Owuor J, Hammond G, Jessup K. What do you need? 2007–2008: findings from a national survey of people with diagnosed HIV. Huddersfield: University of Huddersfield Repository; 2009. Available online at: http://eprints.hud.ac.uk/7402/1/report2009b.pdf [verified 16 August 2016].
[21] Stutterheim S, Sickling L, Brands R, Baas I, Robert H, van Brakel W, Lechner L, Kok G, Bos A. Patient and provider perspectives on HIV and HIV-related stigma in Dutch health care settings. AIDS Patient Care STDS 2014; 28 652–65.
| Patient and provider perspectives on HIV and HIV-related stigma in Dutch health care settings.Crossref | GoogleScholarGoogle Scholar | 25459231PubMed |
