Background: Stigma and Discrimination (S&D) are barriers to uptake and retention in HIV prevention, care, and treatment programs and particularly damaging within health systems. Measuring key actionable S&D drivers is a critical first step to reducing S&D and improving access, linkage, and retention in HIV services. One key actionable driver is worry about HIV transmission in the workplace, which can lead to unnecessary infection control behaviors. These are not only stigmatizing behaviors but can lead to breaches of confidentiality, signaling to others that a client is different in a dangerous way. The USAID-and-PEPFAR-funded HP+ project and UWI-HARP with the MOH and the National Family Planning Board are applying a total-facility approach to S&D-reduction. The first step in Jamaica was collection of baseline data that is informing tailored facility-based S&D-reduction activities and will support evaluation.
Methods: Quantitative survey data was collected in three facilities (July-Sept 2017) with all levels (medical and non-medical) of public sector healthcare workers (HCWs)(n=446) and 292 clients living with HIV. Data on key drivers (fear of HIV transmission/attitudes/health facility environment) and manifestations of S&D were collected from HCWs, while clients reported on experienced discrimination, anticipated stigma and its relationship to health seeking behaviors.
Results: When asked about worry of contracting HIV when conducting five routine activities within the purview of their occupational requirements, doctors (60%) and other medical staff (58%) reported concern/fear of at least one activity (Table 1). Self-reported routine uses of stigmatizing avoidance behaviors with clients living with HIV was high across all categories of staff (Figure 1). For example, HCWs reported using precautionary measures with clients living with HIV that are not used with other clients (48%). HCWs also reported high rates of training in infection control. Clients reported lower levels of experiencing double gloving (8%) in the past 6 months than staff reported using.
Conclusions: Data revealed that despite significant training or other knowledge building interventions, the attitudes or behaviors of key HCW towards PLHIV continue to reflect stigmatizing tendencies. Strengthening understanding and enforcement of the universal application of standard precautions can reduce one common type of S&D in facilities?stigmatizing avoidance behaviors.

Stigmatizing Avoidance Behaviours Towards Clients with HIV by Staff Classification
[Stigmatizing Avoidance Behaviours Towards Clients with HIV by Staff Classification]

Table 1: Areas of Concern about HIV Exposure by Job Category (Percentage)
Areas of Concern Doctors (N=108)Other Medical (N=178)Admin/ Support (N=43)Aux/ Cleaning (N=88)Total (N=417)
Touched the clothing of a client living with HIVWorried4.6%6.2%14.0%20.5%9.6%
Dressed the wounds of a client living with HIVWorried51.1%42.1%0%0%45.5% (N=242)
Drew blood from a client living with HIVWorried54.6%55.8%0%0%55.3% (N=217)
Took the temperature of a client living with HIVWorried0%2.5%0%0%1.6% (N=243)
Gave an injection to a client living with HIVWorried39.8%50.3%0%0%46.4% (N=239)
Composite Indicator:Yes, to at least 1 of 5 applicable items60.2% (65/108)57.9% (103/178)14.0% (6/43)20.5% (18/88)35.9% (192/417)
[Areas of Concern about HIV Exposure by Job Category (Percentage)]

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