HIV stigma in the teaching hospitals, Yemen

Background: Stigma facing People Living with HIV undermines their health, wellbeing and quality of life, and threatens HIV control. HIV control funds and interventions in Yemen diminished gradually, especially after 2015 when donor assistance to emergency relief interventions in 2015. We assessed the level and drivers of HIV stigma in the teaching hospitals in Sana’a city, Yemen. Methods: This was a cross-sectional study that targeted 320 health professionals working in invasive-procedure departments in the three teaching hospitals in Sana'a city in 2017. Data were collected anonymously using a specially designed self-filled questionnaire, which covers providers' background, potential personal and professional drivers of stigma and the stigmatising practices. Data were entered and analysed using SPSS. Results: All participants were Yemeni and the majority were females (68%), 20-39 years old (85%), nurses (84%) and holding a nursing diploma (69%) or a bachelor degree (27%). None of the health professionals was aware of institutional policies against HIV stigma and only 7% believed that the current infection control measures were adequate. A minority of the participants encountered/ provided care for PLHV (%), received HIV training (33%), or were confident that their HIV knowledge was adequate (23%). The majority would test patients for HIV prior to surgical procedures (77%) and discloses a +ve HIV results to others (99%) without the person’s prior knowledge or consent. All the participants applied at least one act of stigma such as avoiding physical contact with PLHIV (87%) or wearing gloves all through the consultation (96.5%). Stigmatizing practices were significantly correlated with poor HIV knowledge and fear of infection (P< 0.05) Conclusions: PLHIV face an epidemic of HIV stigma in the teaching hospitals in Yemen supporting the reports of higher level of stigma in the low HIV prevalence countries and its links to the fear of infection, poor HIV knowledge and lower HIV control funding. Conflict increases vulnerability and exposure to HIV and it is important to maintain the HIV control efforts within this context. Humanitarian efforts should mainstream HIV control measures within the health interventions so as to achieve an equitable and effectively sustainable response.

研究背景：针对艾滋病病毒感染者（People Living with HIV，PLHIV）的污名化行为会损害其健康、福祉与生活质量，并对艾滋病防控工作构成威胁。也门的艾滋病防控经费与干预措施逐步减少，尤其是2015年后，针对应急救灾干预的捐助援助大幅缩减。本研究旨在评估也门萨那市教学医院内艾滋病污名化的水平及其驱动因素。
研究方法：本研究为横断面研究（cross-sectional study），于2017年纳入也门萨那市3家教学医院侵入性操作科室的320名卫生专业人员作为研究对象。采用自行设计的匿名自填式问卷收集数据，问卷内容涵盖研究对象的基本背景、可能导致污名化的个人与职业层面驱动因素，以及污名化行为表现。数据录入与分析均采用SPSS统计软件完成。
研究结果：所有研究对象均为也门籍，其中女性占比68%，20~39岁年龄段占比85%，护士占比84%，持有护理专科文凭者占69%、本科学历者占27%。所有卫生专业人员均未知晓医院针对艾滋病污名化的院内政策，仅7%的受访者认为当前的感染防控措施足够完善。少数受访者曾接触或照护过艾滋病病毒感染者（原文未标注具体占比），33%的受访者接受过艾滋病相关培训，23%的受访者自认艾滋病相关知识储备充足。多数受访者会在外科手术前为患者开展艾滋病病毒检测（77%），且会在未获得感染者本人知情同意的情况下，将其艾滋病病毒阳性检测结果告知他人（99%）。所有受访者均存在至少一项艾滋病污名化行为，例如避免与艾滋病病毒感染者发生身体接触（87%），或在诊疗全程佩戴手套（96.5%）。污名化行为与艾滋病相关知识匮乏、感染恐惧呈显著相关性（P<0.05）。
研究结论：也门教学医院内的艾滋病病毒感染者正面临艾滋病污名化的流行态势，这一结果印证了艾滋病低流行国家污名化水平更高的相关报道，且证实污名化与感染恐惧、艾滋病相关知识匮乏以及艾滋病防控经费不足存在关联。冲突会加剧艾滋病感染的易感性与暴露风险，因此在此背景下持续推进艾滋病防控工作至关重要。人道主义救援工作应将艾滋病防控措施纳入卫生干预措施的主流框架，以实现公平且高效可持续的艾滋病防控应对。