Reducing AIDS stigma among health professionals in South India

Investigator: Maria Ekstrand, PhD
Sponsor: NIH National Institute of Mental Health

Location(s): India


AIDS stigma influences why people don't get tested for HIV, don't tell their sexual partners about their infections, and don't seek treatment or take their medications as prescribed. These behaviors impact both the personal health of those infected as well as the health of the public. This study has been designed to reduce AIDS stigma among health professionals to try to reduce its detrimental impact on individual and public health.

AIDS stigma has long been recognized as a significant barrier in the worldwide fight against HIV. In India, as well as elsewhere, AIDS stigma has repeatedly been shown, not only to inflict hardship and suffering on people with HIV, but also to interfere with decisions to seek HIV counseling and testing, limit HIV-infected individuals willingness to disclose their status to others, and to deter infected individuals from seeking and adhering to medical treatment for HIV-related problems. Members of marginalized groups often experience additional stigma, forcing them to hide their lifestyles and making it more difficult to attend AIDS-related prevention and treatment programs. Although several stigma researchers have called for rigorously evaluated, theory-based stigma reduction interventions, few such programs are in place. Our proposed research aims to fill this gap. This collaborative application builds on findings from our decade-long collaborative research program in South India as well as on research conducted by the International Center for Research on Women (ICRW). Our data show that health professionals often represent a crucial source of AIDS stigma in India, highlighting the need to develop and test interventions in health care settings. ICRW has developed and implemented such an intervention, which has been found acceptable and feasible. A modified version reduced stigma among Indian nursing students in our pilot intervention. The efficacy of this promising intervention is now ready to be formally evaluated in a randomized controlled trial with nursing students and ward attendants; the two types of health care providers who showed the greatest levels of AIDS stigma in our preliminary work. In order for an intervention to have a significant and lasting impact, it also needs to be sustainable, and consider aspects such as staff time constraints. We thus propose to use an innovative delivery model to accomplish these goals: 
1. Adapt the ICRW health care provider stigma reduction intervention for partial tablet PC-based delivery, using interactive touch screen methodology and video vignettes tailored to participant job type. 
2. Conduct a cluster randomized controlled trial to evaluate the efficacy of this intervention in 24 institutions on
   a) the endorsement of coercive policies and intentions to discriminate toward HIV+ patients;
   b) instrumental and symbolic stigma; two factors which have been found to drive the manifestations of stigma in this setting.