Stigma, an important source of dissatisfaction of health workers in HIV response in Vietnam: a qualitative study

Vietnam's Evolving Healthcare System: Notable Successes and Significant Challenges

From regional and rural grassroots to a nationwide level, Vietnam has established a four-tiered hierarchical healthcare system, comprising national, provincial, district, and commune healthcare centers. Over the last three decades, alongside increasing provision of universal health insurance coverage and cutting healthcare expenditure, the country has demonstrated its dedication to preventative medicine and health promotion. Recent investment in research, development, and production has led to "homegrown" vaccines for SARS-CoV-2 now undergoing clinical trial. Nevertheless, despite substantial progress in improving health outcomes for the entire population, the healthcare sector experiences significant challenges. The current public system is paper-based, requires digitalization, and lacks information technology support. In common with many other countries, there is a vast disparity in the distribution of healthcare professionals between cities and rural areas, as well as between private and public sectors. Consequently, public healthcare in remote locations is particularly underserved. Moreover, ongoing underfunding caused by high out-of-pocket expenses for the average salary, as well as stigmatization of sensitive health issues by a largely conservative populace, demand a well-articulated and culturally sensitive approach. As the level of smartphone ownership and internet coverage are both comparatively high for Southeast Asia, the introduction of telemedicine, mobile health applications, and other digital health solutions may be both practicable and beneficial. Importantly, in order to develop healthcare facilities and reduce patient direct payments, the key issue of funding must be addressed. In order to overcome disease-related stigma, a locally tailored program of community education, awareness, and engagement is required. In summary, in several ways, Vietnam provides a role model for developing healthcare systems in low- and middle-income countries. There are undoubted hurdles to overcome, but the country continues to construct a healthcare system that is accessible and affordable for the majority.

A qualitative inquiry of rural-urban inequalities in the distribution and retention of healthcare workers in southern Nigeria

Introduction

Globally, the population in rural communities are disproportionately cared for by only 25% and 38% of the total physicians and nursing staff, respectively; hence, the poor health outcomes in these communities. This condition is worse in Nigeria by the critical shortage of skilled healthcare workforce. This study aimed to explore factors responsible for the uneven distribution of healthcare workers (physicians and nurses) to rural areas of Ebonyi State, Nigeria.

Methods

Qualitative data were obtained using semi-structured in-depth interviews and focus group discussions from purposively selected physicians, nurses, and policymakers in the state. Data was analysed for themes related to factors influencing the mal-distribution of healthcare workers (physicians and nurses) to rural areas. The qualitative analysis involved the use of both inductive and deductive reasoning in an iterative manner.

Results

This study showed that there were diverse reasons for the uneven distribution of skilled healthcare workers in Ebonyi State. This was broadly classified into three themes; socio-cultural, healthcare system, and personal healthcare workers’ intrinsic factors. The socio-cultural factors include symbolic capital and stigma while healthcare system and governance issues include poor human resources for health policy and planning, work resources and environment, decentralization, salary differences, skewed distribution of tertiary health facilities to urban area and political interference. The intrinsic healthcare workers’ factors include career progression and prospect, negative effect on family life, personal characteristics and background, isolation, personal perceptions and beliefs.

Conclusions

There may be a need to implement both non-financial and financial actions to encourage more urban to rural migration of healthcare workers (physicians and nurses) and to provide incentives for the retention of rural-based health workers.

Intersecting Stigmas among HIV-Positive People Who Inject Drugs in Vietnam

HIV-related stigma remains a barrier to ART adherence among people living with HIV (PLWH) globally. People who inject drugs (PWID) may face additional stigma related to their behavior or identity; yet, there is little understanding of how these stigmas may co-exist and interact among these key populations. This study aims to explore the existence of multiple dimensions of HIV-related stigma, and how they may intersect with stigma related to drug injection. The study took place in Vietnam, where the HIV epidemic is concentrated among 3 key population groups; of those, PWID account for 41% of PLWH. The vast majority (95%) of PWID in Vietnam are male. Data came from in-depth interviews with 30 male PWID recruited from outpatient clinics, where they had been receiving ART medications. Deductive, thematic analysis was employed to organize stigma around the 3 dimensions: enacted, anticipated, and internalized stigma. Findings showed that HIV- and drug use-related stigma remained high among participants. All 3 stigma dimensions were prevalent and perceived to come from different sources: family, community, and health workers. Stigmas related to HIV and drug injection intersected among these individuals, and such intersection varied widely across types of stigma. The study revealed nuanced perceptions of stigma among this marginalized population. It is important for future studies to further investigate the influence of each dimension of stigma, and their interactive effects on HIV and behavioral outcomes among PWID.

Stigma and Dissatisfaction of Health Care Personnel in HIV Response in Iran: A Qualitative Study

Background and Aims:

With regard to the disease pandemics of HIV/AIDS, it is clear that there is need for prevention, treatment, care, and support of HIV positive patients in the health care system. In order to achieve these goals, job satisfaction should be a priority for health care staff. This study examined the problems of health care personnel and the behavior of patients undergoing HIV/AIDS counseling at Imam Khomeini Hospital in Tehran, Iran.

Methods:

Interviews were conducted individually with 5 health care personnel who participated in this study. Participants had 30 to 45 minutes each per session at the clinic, during which they were able to discuss the problems they faced in their careers. All conversations were officially recorded.

Results:

The most common problems mentioned by these health care workers included the lack of safety and standardization of work conditions, the lack of appropriate equipment, limited space, high numbers of patients, low staffing levels and financial and morale problems compounded by the lack of support by hospital authorities.

Conclusion:

The authorities need to allocate more funds to provide facilities and appropriate working conditions for health care staff in order to increase job satisfaction and enable staff to provide the best services and care to HIV positive patients.

Changing Sources of Stigma against Patients with HIV/AIDS in the Rapid Expansion of Antiretroviral Treatment Services in Vietnam

Stigmatization against HIV/AIDS greatly hinders efforts to increase the accessibility and utilization of HIV/AIDS services to meet the 90-90-90 goal. This study assessed the stigmatization and discrimination experienced by people living with HIV (PLWH) across multiple social settings such as family, community, and healthcare facilities in Vietnam. A total of 1,016 patients (63.8% males, mean age = 35.4) participated in a cross-sectional study using a culturally tailored HIV stigma measure in three HIV-epidemic-concentrated cities in Vietnam. Zero-inflated Poisson models were used to examine factors associated with the number of types of stigma that patients experienced. 86.2% PLWH reported experiencing stigma against HIV/AIDS, more frequently from their community (62.8%) and family (30.2%) than from health care facilities (8%). The level of stigma from community reported by PLWH is associated with socioeconomic status (e.g., income, occupation). The poor and middle economic classes and unemployed patients reported more stigmatization and discrimination from the community. Across all settings, PLWH experienced fewer stigmatization over the course of ART indicating the benefits of rapidly expanded ART programs. PLWH reported more stigmatization and discrimination at the provincial level of the health administration. Those with the history of drug injection reported significantly less stigmatization from healthcare setting. More culturally tailored interventions to reduce stigmatization overall to improve the quality of life and health outcomes of PLWH should be warranted to achieve the 90-90-90 goal. Improving HIV-related knowledge of the general population and providing opportunities for PLWH to be reintegrated into should be considered. Using mass media with positive messages and images would also foster positive attitudes towards HIV/AIDS among the population and could potentially change social values. Continuous training of health staffs' attitude could minimize the occurrence of stigmatization and discrimination at healthcare facilities.

Righting the Misperceptions of Men Having Sex with Men: A Pre-Requisite for Protecting and Understanding Gender Incongruence in Vietnam

Protecting the rights of the lesbians, gays, bisexuals, transgender, intersex, and queers (LGBTIQ) population requires, first and foremost, a proper understanding of their sexual orientation and gender identity. This study highlights a severe misunderstanding and lack of knowledge among health professionals in Vietnam with regard to the men who have sex with men (MSM) and transgenders. This study uses (i) a survey based on the convenience sampling method among 150 health workers that covered 61 questions and (ii) 12 in-depth interviews in two metropolitan centres in Vietnam, Hanoi and Ho Chi Minh city. Three main topics are explored: (i) the general knowledge of healthcare workers about MSM and transgenders; (ii) their knowledge about the sexual reproductive health and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) risks of MSM and transgenders; and (iii) their attitudes and behaviors towards MSM and transgenders. One of the notable findings is how prevalent the misperceptions are across the board, namely, in staff of both sexes, in both cities, at various kinds of medical facilities, at different work positions and educational levels. Half of the respondents consider transgenders to have a curable mental problem while 45% say MSM only have sex with males. Most remarkably, 12.7% state if they have any choice, they want nothing to do with MSM and transgenders. The study finds there is a considerable percentage of health professionals who lack knowledge about the diversity of sexual orientation, gender identity, and health issues related to the sexual minorities and gender non-conforming population. To improve the clinical process for serving these at-risk groups, the study suggests the continual education for the health workers needs to be added to their formal as well as in-job training.

Willingness to care for blood-borne virus-infected patients in Thailand

Background

Although stigma and discrimination by nurses against patients infected with human immunodeficiency virus (HIV) or hepatitis C virus (HCV) have been reported, potential determinants of nurses' willingness to care for these patients have not been well studied in Thailand.

Aims

To identify factors associated with Thai nurses' willingness to care for patients infected with HIV or HCV.

Methods

Multivariable logistic regression analysis of data from a questionnaire completed by nurses at a large hospital in Bangkok, Thailand.

Results

Of 626 nurses, 546 (87%) nurses participated. Eleven per cent (59) and 6% (34) had previously experienced HIV- or HCV-infected blood contamination incidents, respectively. Forty-four per cent (240) and 38% (208) reported unwillingness to care for HIV- or HCV-infected patients, respectively. Willingness to care was less common [adjusted odds ratios 0.51 (0.34-0.74) for HIV and 0.62 (0.42-0.89) for HCV] in nurses aged ≥ 40 years and in those who feared HCV [0.63 (0.37-0.99)], but not HIV [0.84 (0.5-1.26)] transmission. Nurses who had confidence in protecting themselves against infection with HIV [1.84 (1.52-2.04)] and HCV [1.87 (1.45-2.18)], and accepting attitudes towards HIV-infected co-workers [1.39 (1.08-1.66)] but not HCV-infected co-workers [1.16 (0.83-1.5)], were more willing to care for HIV- and HCV-infected patients.

Conclusions

Around 4 in 10 Thai nurses in our sample were unwilling to care for HIV- or HCV-infected patients. Minimizing the risk of nosocomial transmission and improving the public perception of infected individuals may help improve nurses' willingness to care for such patients, in Thailand or elsewhere.

Patient and provider attitudes to emergency department-based HIV counselling and testing in South Africa

Background

The national South African HIV Counselling and Testing (HCT) guidelines mandate that voluntary counselling and testing (VCT) should be offered in all healthcare facilities. Emergency departments (EDs) are at the forefront of many healthcare facilities, yet VCT is not routinely implemented in this setting.

Methods

We conducted a cross-sectional study that surveyed patients and healthcare providers at a tertiary care ED in the spring and summer of 2016 to ascertain their attitudes to VCT in the ED. We also used two previously validated survey instruments to gather data on patients’ HIV knowledge and providers’ stigma against patients living with HIV, as we anticipated that these may have an impact on providers’ and patients’ attitudes to the provision of HIV testing within the ED, and may offer insights for future intervention development.

Results

A total of 104 patients and 26 providers were enrolled in the study. Overall, patients responded more favourably to ED-based HIV testing (92.3%) compared to providers (only 40% responded favourably). When asked about potential barriers to receiving or providing HIV testing, 16.4% of patients and 24% of providers felt that the subject of HIV was too sensitive and 58.7% of patients and 80% of providers indicated that privacy and confidentiality issues would pose major barriers to implementing ED-based HIV testing.

Conclusion

This study shows that while ED-based HIV testing is overall highly acceptable to patients, providers seem less willing to provide this service. The survey data also suggest that future development of ED-based testing strategies should take into consideration privacy and confidentiality concerns that may arise within a busy emergency care setting. Furthermore, every effort should be made to tackle HIV stigma among providers to improve overall attitudes towards HIV-positive individuals that present for care in the ED.

Nurses' willingness to care for patients infected with HIV or Hepatitis B / C in Vietnam

OBJECTIVES

This study examined the factors associated with nurses' willingness to care for patients infected with human immunodeficiency virus (HIV) or hepatitis B or C virus (HBV/HCV) in Vietnam.

METHODS

A cross-section of 400 Vietnamese nurses from two hospitals were selected using stratified random sampling, to whom a self-administered questionnaire was administered which included demographic items, previous experience with patients infected with HIV or HBV/HCV, and their attitudes toward these patients. Data was analyzed using descriptive statistics and multiple logistic regression.

RESULTS

The lifetime prevalence of needlestick or sharps injury whilst caring for a patient infected with HIV or HBV/HCV was 9 and 15.8%, respectively. The majority of participants expressed a willingness to care for patients infected with HIV (55.8%) or HBV/HCV (73.3%). Willingness to care for HIV-infected patients was positively associated with being 40-49 years of age and confidence in protecting themselves against infection. Regarding HBV/HCV infection, willingness to care was positively associated with individual confidence in protecting themselves against infection.

CONCLUSIONS

This study revealed that Vietnamese nurses were somewhat willing to care for patients infected with HIV or HBV/HCV, and this was associated with individual confidence in protecting themselves against infection and with negative attitudes towards HIV and HBV/HCV. Establishing a positive safety culture and providing appropriate professional education to help reduce the stigma towards infected patients offers an effective way forwards to improve quality of care in Vietnam, as elsewhere.

Prevalence and factors associated with occupational burnout among HIV/AIDS healthcare workers in China: a cross-sectional study

Background

Burnout is a psychosomatic syndrome characterized by three dimensions (emotional exhaustion [EE], feelings of depersonalization [DP], and reduced personal accomplishment [PA]). We determined the prevalence of burnout and mental health status between HIV/AIDS healthcare workers and other healthcare workers, and determined the factors associated with burnout of HIV/AIDS healthcare workers.

Methods

All participants were asked to complete a self-administered questionnaire. The participants were recruited from the departments of infectious diseases in four hospitals which treated HIV/AIDS. The questionnaire included demographics, the Maslach Burnout Inventory-General Survey (MBI-GS), the Symptom Checklist 90 (SCL-90), the Eysenck Personality Questionnaire (EPQ), and the Trait Coping Style Questionnaire (TCSQ).

Results

A total of 512 questionnaires were distributed; 501 questionnaires were completed and collected (the response rate was 97.9 %). After eliminating nine invalid questionnaires (1.80 %), 264 physicians and nurses caring for HIV/AIDS and 228 physicians and nurses caring for other infectious diseases provided valid responses (98.2 %). The HIV/AIDS healthcare workers’ scores on the emotional exhaustion (F = 6.350, p = 0.012) and depersonalization dimensions (F = 8.533, p = 0.004) were significantly higher than other healthcare workers. The HIV/AIDS healthcare workers had higher total scores and positive items on the Symptom Checklist 90 (SCL-90) compared with other healthcare workers. Low job satisfaction, serious somatization, interpersonal sensitivity, poor quality of sleep, high psychoticism scores, and use of negative coping styles were frequently associated with burnout.

Conclusions

Burnout was shown to be highly prevalent in HIV/AIDS healthcare workers, 76.9 % of whom met the accepted criteria for burnout. In addition, compared with other healthcare workers, HIV/AIDS healthcare workers experienced lower levels of psychological health. Interventions should be targeted at reducing the occurrence of burnout and alleviating psychological pressure amongst HIV/AIDS healthcare workers.

HIV Stigma Toward People Living With HIV and Health Providers Associated With Their Care: Qualitative Interviews With Community Members in Egypt

We explored perceived HIV stigma by community members in a low-HIV-prevalence setting toward people living with HIV (PLWH) and physicians associated with HIV in order to develop operational stigma reduction recommendations for HIV referral hospitals. In-depth interviews (N = 30) were conducted with educated and less-educated men and women in Egypt. Thematic analysis was applied to identify drivers, manifestations, and outcomes of stigma. Stigma toward PLWH was rooted in values and fears, manifesting in reluctance to use the same health facilities as PLWH. Stigma toward physicians providing care for PLWH was caused by fear of infection and developed into unwillingness to use those physicians' services. Stigma toward physicians who refused to provide care was linked to perceptions of unethical behavior. HIV referral hospitals in low HIV prevalence settings could benefit from stigma reduction interventions with a special focus on addressing moral-based stigma and fear of casual transmission.

Knowledge of HIV and factors associated with attitudes towards HIV among final-year medical students at Hanoi medical university in Vietnam

Background

The success of HIV care strongly depends upon skills of the healthcare worker. Vietnam has a punitive history towards HIV and even though this has changed recently, persons living with HIV are still facing discrimination. The objective of this paper is to assess the gaps in knowledge of HIV and factors associated with discriminatory attitudes towards persons living with HIV among medical students in order to improve medical training.

Methods

In a cross-sectional quantitative study using a structured questionnaire, 200 final-year medical students at Hanoi Medical University were approached for data collection in May of 2012. Descriptive statistics (percentages) were used to present four HIV knowledge tests. Linear regression models were examined to highlight factors that are associated with general attitudes towards HIV and attitudes towards HIV in a clinical setting.

Results

Although students performed overall well in the knowledge category of HIV discrimination and stigma, there were several gaps in knowledge of HIV, including the categories of HIV-related basic sciences, prevention, and care and treatment. Knowledge of stigma and discrimination was a significant positive predictor of General non-prejudicial attitude to HIV and AIDS (β = 0.186, P < 0.01) and Non-discriminatory attitude to HIV and AIDS at work (β = 0.188, P < 0.01). Training on methadone treatment was found to be a significant positive predictor (β = 0.168, P < 0.05) while family size was negatively associated (β = -0.170, P < 0.05) with General non-prejudicial attitude to HIV and AIDS.

Conclusions

The study suggests a need for incorporating HIV training into the core curricula for medical students. As persons who inject drugs carry a proportionately high burden of HIV in Vietnam, it is also important to include methadone training for students.

Effectiveness of train-the-trainer HIV education: a model from Vietnam

As HIV prevention and treatment efforts expand around the globe, local capacity-building to update and maintain nurses' HIV competence is essential. The purpose of this project was to develop and sustain a national network of nurse-trainers who could provide ongoing HIV continuing education and training experiences to Vietnamese nurses. Over the course of 6 years, 87 nurses received training to become HIV trainers; their HIV knowledge increased significantly (p = .001), as did teaching self-confidence (p = .001 to .007). The 87 nurses subsequently reported training more than 67,000 health care workers. Recipients of train-the-trainer-led workshops demonstrated increased HIV knowledge (p = .001) and increased willingness to provide nursing care for HIV-infected patients (p = .001). The program demonstrated that including a substantial amount of instruction in pedagogical strategies and experiential learning could enhance knowledge transfer, expand education outreach, and contribute to sustainable HIV competence among nurses.