Intervening in HIV/AIDS Provider Stigma: Assessing Regional Concerns in the West Indies by

Description:

Abstract:
Objectives Overviews tenets of the Awareness/Acceptance/Action model (AAAM) as employed in anti-stigma workshops guiding providers of health care and social services to recognize their attitudes and behaviors that inhibit PLHA and their caregivers from accessing and adhering to testing, treatment, and care. Based on theories of social cognition and mindfulness, the AAAM promotes appreciating the impact of attitudes and behaviors on service provision. Summarizes initial data obtained in three workshops in Barbados, Grenada, and Trinidad & Tobago. Design & Methods In regional workshops conducted from 2003-2005, persons directly and indirectly engaged with persons at risk for, infected with or affected by HIV/AIDS were surveyed on their experiences with stigma. Questionnaires were designed to sensitize participants to their own fears regarding instrumental and symbolic stigma. Descriptive and bivariate analyses identified similarities and differences within and across nationalities. Results Ninety participants across sites reported warmth expressed for PLHA (where 100 = highest) as m = 28.6 (s.d. = 32.9) for MSM and m = 75.5 (s.d. = 26.7) for children. Feelings reported towards PLHA (where 7 = strongest agreement) were sympathy (m = 5.89, s.d. = 1.45), anger (m = 2.55, s.d. = 1.81), fear (m = 2.84, s.d. = 1.93), and disgust (m = 2.0, s.d. = 1.52), and confidence in counseling others on relating to PLHA (where 7= very effective) was moderate (m = 5.41, s.d. = 1.66). Conclusions Tendencies to distance from and deny stigmatizing attitudes and behaviors impair the delivery of health care and social services to PLHA. AAAM components, compatible with CAREC's health promotion principles, provide a basis for addressing these directly, and a vehicle for promoting less stigmatized service delivery. Future research should emphasize validating measures of experienced and expressed stigma, and evaluate extended-format workshops.