Results of a study on HIV stigma among healthcare workers, Sri Lanka

1. HIV Stigma Index among
Healthcare Workers

2. General Objective
• To ascertain the HIV knowledge, attitudes and
level of stigma & discrimination towards
people living with HIV among healthcare
workers, in selected healthcare settings in
Colombo.

3. Specific Objective
1. To assess the level of stigma among healthcare
providers towards PLHIV
2. To describe the knowledge and general attitudes
towards PLHIV
3. To describe the knowledge and practices related to
standard precaution

4. Study Setting
National Hospital of Sri Lanka De Soysa Maternity Hospital Lady Ridgeway Hospital for Children
Castle Street Hospital for Women National STD/AIDS Control Programme Hospital, Angoda
Base

5. Study Design
• Cross sectional study
design

6. Sampling technique and sample size
Institutions:
1. NHSL, 2. DMH, 3. CSHW, 4. LRH, 5. • Quota sampling was done
CSTDC, 6. BH(Angoda) considering the relative
Category of staff:
1. DOCs, 2. NOs, 3. MLTs, 4. ATs, 5. LAs
proportions of healthcare
workers.
Estimated Population: 5898
Category Sample size
Doctors 130
Nursing officers 205
MLTs 92
Attendants 154
Labourers 251
Total 832
Sample: 832 (14.1%)

7. Ethical considerations
• Informed consent
• Voluntary
participation/Autonomy
• Confidentiality
• Data security
• Ethical clearance was taken
from the ethics committee of
the faculty of Medicine,
University of Peradeniya

8. RESULTS

9. Age distribution
Mean age of the sample was 41 years (SD, 10.6 years)
Range 38-41.7 years
Category of staff Mean age N SD
Doctors 41.73 130 9.737
Nursing staff 39.93 205 10.559
MLTs 38.51 91 9.744
Attendants 48.35 147 6.150
Labourers 38.06 246 11.454
Total 41.01 819 10.612

10. Distribution of the sample by category of staff
Over half of the sample is represented by the Nursing staff
(24.6%) and hospital labourers (30.2%)
Category of staff Frequency Percent Cumulative Percent
Doctors 130 15.6 15.6
Nursing staff 205 24.6 40.3
MLTs 92 11.1 51.3
Attendants 154 18.5 69.8
Labourers 251 30.2 100.0
Total 832 100.0

11. Experience as a healthcare worker
Average years of experience was 15 years
Category of staff Mean years Standard Deviation (Months)
Doctors 13.10 9.7069
Nursing staff 15.70 10.9271
MLTs 13.13 10.0739
Attendants 22.67 6.1455
Labourers 11.06 9.0230
Total 14.90 10.1572

12. Provision of care to an HIV patient
Have you ever provided care to an HIV patient
100
90 85.9
80 Yes No Don't know
70 66.7 67.8
60.9
60
Percent
49.8
50 43.3
40
30.5
30
18.6 18.5
20 14.7 13.7 10.9 8.6
10 6.9
3.3
0
Doctors Nursers MLTs (N=92) Attendants Labourers
(N=129) (N=205) (N=151) (N=245)

13. Cause of Stigma & Discrimination
Fear of HIV transmission by type of contact
with people living with HIV/AIDS

14. Fear of HIV transmission by type of contact
Labourers Attendants MLTs Nurses Doctors
Giving
inj/drip 34.1
53.5
72.7
Dressing 62.3
wounds 41
60.8
32.7
Touching 28.5
40
saliva 23.4
35.4
12
Touching 11.7
14.3
sweat 4.9
6.2
0 10 20 30 40 50 60 70 80
Percent

15. Fear of HIV transmission by type of contact
Giving injec/drip Dressing wounds Touching saliva Touching sweat
Labourers 72.7
32.7
12
Attendants 62.3
28.5
11.7
MLTs 40
14.3
34.1
Nurses 41
23.4
4.9
53.5
Doctors 60.8
35.4
6.2
0 20 40 60 80
Percent

16. Cause of Stigma & Discrimination
Morality related attitudes towards
PLHIV

17. Morality Related Attitudes towards PLHIV
Labourers Attendants MLTs Nurses Doctors
I feel ashamed if someone in my family 69.7
72.7
44
infected 35.1
44.2
74.5
79.2
I feel ashamed if I was infected 50.5
47.3
55.4
30.8
45.8
It is the FSWs who spread the disease 33
23.4
40
Promiscuous men are the once that 62.4
70.8
58.9
spread the disease 52.2
55
51
61.2
Ashamed of themselves 13.2
5.4
6.2
66.9
69.9
Punishment for bad behaviours 35.2
26.3
16.2
11.6
13
Karume/punishment from God 11
2
6.2
0 20 40 60 80 100
Percent

18. Enacted Stigma (Discrimination)

19. In the past 12 months have you seen the following happen in your health facility
because a client was known to have or was suspected of having HIV/AIDS
Labourers Attendants MLTs Nurses Doctors
HCWs gossiping about the patient's HIV 10.1
6.5
46.2
status 27.3
41.5
Testing the patient without patient's 31.1
36.8
18.9
consent 29.8
22.3
22.8
Pass on the patient to to others 22.9
15.4
10.2
18.5
Use of latex gloves unnecessarily for 27.1
32
29.7
performing external examinations 30.7
30
Requiring some patients to be tested for 63.7
64.7
63.7
HIV before scheduling surgeries 66.3
56.2
Extra precausions being takenin the 73.6
82.2
67
sterilization of instruments used for HIV… 74.6
57.7
Receiving less care/attention than other 12.4
11.7
11
patients 12.2
13.1
0 20 40 60 80 100
Percent

20. Stigma Index
(21-Item Stigma Index)

21. 21-Item Stigma index
• Twenty-one item stigma Index used in this study to measure the level of
HIV stigma among healthcare workers.
• Scoring was done on a three-point Likert scale (agree, can’t say, disagree)
ranging from 1 to 3 with the score of 21 as minimum and 63 as the
maximum score
• The scoring was done according to the responses on the statements in the
21-item stigma scale.
Stigmatizing Non Stigmatizing
statement statement
Agree 3 1
Disagree 1 3
Cant say 2 2
• Higher score on the index denotes a higher level of stigma

22. HIV Stigma Index among Healthcare workers
Stigma Index by category of staff
Stigma Scale (22-63)
Laboures, 36.9
Attendants, 37.3
MLTs, 37.1
Nursing Officers, 31.6
Doctors, 33.4
21 24 27 30 33 36 39 42 45 48 51 54 57 60 63
Stigma Scale (21-63)

23. HIV/AIDS Knowledge among
Healthcare Workers

24. Knowledge on HIV transmission
Labourers Attendants MLTs Nurses Doctors
4.8
Can a person get HIV by sharing a meal with 2.6
0
someone who infected 2
4.6
16
Can a person get HIV infection from 7.8
3.3
mosquito bites 3.4
3.8
73.3
Can a healthy looking person have HIV 78.6
91.2
infection 93.7
98.5
88
Can the risk of HIV be reduced by using 92.9
92.3
condoms 92.6
94.6
92
Can the risk of HIV be reduced by having sex 93.5
97.8
with only one faithful, uninfected partner 94.1
94.6
0 20 40 60 80 100
Percent

25. Occupational exposure to blood
Prevalence of percutaneous injuries and splashes

26. Prevalence of percutaneous injuries or splashes
Labourers Attendants MLTs Nurses Doctors
2.4
blood splashes on 2.6
15.4
mm/non-intact skin 12.2
11.5
cut with a sharp 0.8
instrument 2.6
13.2
(Contaminated with 3.4
blood) 8.5
2.4
Needle pricks 3.2
(Contaminated with 9.9
blood) 14.1
23.1
0 20 40 60 80 100
Percent

27. Knowledge on post-exposure
management

28. Knowledge on post-exposure management of
needle prick injuries
Labourers Attendants MLTs Nurses Doctors
Report to infection 79.3
81.2
82.4
control staff 92.2
80
58.2
59.7
Report to head 67
79
52.3
13.5
11
Dress the wound 9.9
23.9
13.1
35.1
44.8
Squeeze/Bleed wounds 63.7
62.9
32
Clean wound with 49
40.9
61.5
sntiseptics 56.1
59.2
Wash with soap and 49.4
57.1
69.2
water 89.3
70.8
0 20 40 60 80 100
Percent

29. Under what circumstances should a healthcare
worker seek PEP
Labourers Attendants MLTs Nurses Doctors
21.1
HIV positive blood contact 26.6
33
with intact skin 22.9
22.5
48.6
Any blood contact with 51.9
52.7
non-intact skin 61.5
51.9
47.4
Any blood contact with 52.6
57.1
mucous membranes 55.1
56.6
71.6
Needle stic injury from an 77.3
90.1
HIV patient 89.8
90.7
45
47.4
Any needle stick injury 46.2
48.8
33.3
0 20 40 60 80 100
Percent

30. What should be done to prevent HIV
transmission to Healthcare workers

31. In your opinion, what should be done to prevent HIV
transmission to HCWs in hospital setting
Labourers Attendants MLTs Nurses Doctors
HIV patients should have a separate 27.5
23.4
22 26.2 40.7
healthcare institution
Assume that every pt has HIV and always 63.3
63.6 90.196.1
take precausions 77.7
2.4
1.9
Do not accept HIV pt's to hospitals 1 4.4
4.6
15.9
18.8
Supply enough PEP 45.4 53.8 64.6
Inform all hospital workers about HIV pt's 34.440.2
31.9
21.527.8
30.7 40.3
Have enough clean running water to wash 54.9 62.4
55.4
Wear special protections when touching HIV 57
65.9 74
pt's 64.6 71.2
20.7
24
Test every patient for HIV 18 24.2
7.7
35.1 42.9
Supply enough gloves 66.3 73.178
0 20 40 60 80 100
Percent

32. Conclusions and Recommendations (1 of 5)
• Results showed that about 23%-38% stigma level
among healthcare workers
• Prevailing level of HIV stigma and discrimination
among HCWs is a reflection of the situation in the
society. Therefore, fighting against HIV stigma
and discrimination should not be confined to
healthcare settings. It should be a broad
approach which should include PLHIV, healthcare
workers and general population as whole.

33. Conclusions and Recommendations (2 of 5)
• Fear of HIV transmission is one of the reasons for
stigmatizing patients with HIV. It has been
observed to be prevalent among all the
categories of staff.
• Morality related attitudes are not uncommon
among HCWs which is also a cause of stigma
• stigma cannot be eliminated, but discriminatory
actions can be eliminated within the healthcare
settings (Target - zero discrimination by 2015)

34. Conclusions and Recommendations (3 of 5)
• It is difficult to expect respectful, stigma free
behaviours among HCWs unless they are specially
trained to deal with an HIV positive patients
• Most of the time doctors are missing in lot of training
interventions. This study showed the importance of
inclusion of all the categories of staff for better results
• Although HCWs have the responsibility to adhere to
standard precautions and equal rights for treatment
care and support, decision makers in the healthcare
system should also have the responsibility to make
prevention supplies and PEP available.

35. Conclusions and Recommendations (4 of 5)
• Healthcare providers are not free of
misperceptions, misconceptions and
judgemental attitudes towards PLHIV which
persist in society at large, and need to be
addressed

36. Conclusions and Recommendations (5 of 5)
Healthcare providers should have their own
rights to be protected from HIV and ways of
upholding their rights
BUT
without denying the rights of PLHIV

38. Sponsors

39. Acknowledgement
Principal Investigator: Dr. D Ajith Karawita
Co-investigators: Dr. KAM Ariyaratne, Dr. Manoji Gunathilake
Contributors
Prof. A Pathmeswaran, Dr. Sujatha Samarakoon, Dr. S. Benaragama, , Dr. Sunera
Fernando, Mr Hans Billimoria, Mrs Sherine Rodrigo
UN Agencies: Dr. Indira hettiarachchi, Ms. Swairee Rupasinghe, Dr. Dayanath
Ranatunge
AIDS Foundation of Lanka: Dr. Palitha Abeykoon, Dr. Sarojini Perera
We would like to acknowledge the support extended by the National STD/AIDS
Control Programme, National Hospital of Sri Lanka (NHSL), De Soysa Maternity
Hospital (DMH), Lady Ridgeway Hospital for Children (LRH), Castle Street Hospital
for Women (CSHW) and Base Hospital Angoda (Infectious Disease Hospital)
Most importantly we, would like to thank all the healthcare workers who
participated in the research
Dr. Darshani Wijewickrama and Dr Sathya Herath for translations
Ms Nimali Magammana, Sister Chandrani Kumari Rajakarune, Nalaka Gamage, RW
Bandara, Ms. Wasanthi Rajapakse, Ms. Anoma for data collection and data entry.