Abstract
HIV stigma is the remaining challenge to end the global epidemics of HIV. Whether stigma may form a barrier to the provision of ART within the community-based, primary care setting was not studied yet. Therefore, this study intended (1) to compare the levels of 'perceived stigma' in PLHIV attending district hospital and primary care units (PCUs), and (2) to measure the relation between HIV stigma and the satisfaction of patients with their health service. In this cross-sectional study, two matched PLHIV attending district hospitals were recruited for every PLHIV attending a PCU, within a pilot project, until the end of 2014. 198 informed and consented participants were recruited. We used validated Thai version instruments to measure the levels of 'perceived stigma' and 'internal shame' and the Patient Satisfaction Questionnaire 18 (PSQ18) to measure patients' satisfaction with the health service. Analysis applied MANOVA and multivariate robust regression. The level of 'perceived stigma' and 'internal shame' levels were not significantly different between district hospitals attendants and PCU attendants (P>0.05 MANOVA). Moreover, the more patients were satisfied with the health service, the less likely to have 'perceived stigma' (β -5.9, 95% confidence interval -7.7 to -4.1) and 'internal shame' (β -5.7, 95% CI -8.3 to -3.2), P<0.001). HIV associated stigma would be minimized through the attempt to promote PLHIV's satisfaction with ART service. There is ample role of health professional education and training to improve patients' satisfaction. It may contribute to the aim of zero discrimination.
Highlights
HIV stigma is the remaining challenge to end the global epidemics of HIV
Many researchers have reported the impact of stigma on the health seeking behaviors of people living with HIV (PLHIV), literature is still lacking on how HIV stigma is affected in relation to antiretroviral therapy (ART) services
The objectives of this study were (1) to measure and compare the levels of stigma perceived by PLHIV accessing ART services task-shifted to primary health care centers with those accessing routine HIV clinic care at district hospitals; (2) to measure the gender difference in HIV stigma levels; and (3) to test the relation between HIV-related stigma and the satisfaction of patients with their HIV healthcare service
Summary
HIV stigma is the remaining challenge to end the global epidemics of HIV. Whether stigma may form a barrier to the provision of ART within the community-based, primary care setting was not studied yet. This study intended (1) to compare the levels of ‘perceived stigma’ in PLHIV attending district hospital and primary care units (PCUs), and (2) to measure the relation between HIV stigma and the satisfaction of patients with their health service. Results: The level of ‘perceived stigma’ and ‘internal shame’ levels were not significantly different between district hospitals attendants and PCU attendants (P>0.05 MANOVA). Over the last three decades of the HIV epidemic, there has been both qualitative and quantitative evidence revealing the negative impact of HIV-related stigma, such as avoidance of HIV testing, delayed seeking and nonutilization of HIV services, missing pills for antiretroviral therapy (ART), and poor HIV outcomes [1,2,3]. Many researchers have reported the impact of stigma on the health seeking behaviors of PLHIV, literature is still lacking on how HIV stigma is affected in relation to ART services
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