卫生保健环境中的艾滋病毒污名化：监测《关于在欧洲和中亚建立伙伴关系防治艾滋病毒/艾滋病的都柏林宣言》的执行情况

BackgroundIftheAIDSepidemicistobebroughttoendby2030,itiscrucialtocombatHIV-relatedstigmaanddiscriminationinhealthcaresettings,asperUnitedNations(UN)SustainableDevelopmentGoal3Target3.3[1]andtheParisDeclaration[2].TheUNAIDStargetrelatedtostigmaanddiscriminationisthatlessthan10%ofpeoplelivingwithHIVandotherkeypopulationsexperiencestigmaanddiscrimination[3].HIVstigmaisarecognisedbarriertoachievingpositivehealthandwell-being,linkedtonegativehealthcareoutcomessuchasdelayedcare,avoidanceofhealthfacilities,andpooradherencetomedication,ultimatelyhamperingHIVpreventionandtreatmentefforts.Understandinghowandinwhichcontextsstigmamanifestsinhealthcaresettings,andwhatunderpinsstigmatisingactionsandbehaviouramonghealthcareworkers,isnecessarytounderstandhowbesttointerveneandaddressindividualandinstitutionaldriversofstigmaanddiscriminationtowardspeoplelivingwithHIV.MethodsTheEuropeanCentreforDiseasePreventionandControl(ECDC)andtheEuropeanAIDSClinicalSociety(EACS)recentlyworkedtogethertoacquireknowledgeontheoccurrenceofHIV-relatedstigmaanddiscriminationamongpeopleworkinginvarioushealthcaresettingsinEuropeandCentralAsia.Asurveywasdevelopedbyamulti-stakeholdergroup(seeAnnex1),basedonanexistingquestionnaire.Thissurvey,whichaddressedanyoneworkinginthehealthcaresector,includingclinicalandnon-clinicalprofessionals,wasundertakenbetween15Septemberand5December2023.Anon-probabilitysamplewasrecruitedviaamulti-channelcampaign,leveragingnationalandinternationalhealthcareprofessionalnetworks,socialmedia,newsletters,anddirectcommunicationsatprofessionalevents.Datacollectioninvolvedanonlinequestionnaire,availablein38languages,inquiringabouttheagreementoftherespondentswithHIV-relatedstatements,training,personalattitudesandbehaviourtowardspeoplelivingwithHIV,andobservedpracticesandpoliciesrelatedtoHIVattheirhealthcarefacilities.Duetothenon-probabilitynatureofthesample,therearelimitationsontheextenttowhichtheresultscanbegeneralised.However,thefindingsprovideindicationsofthelevelandcharacteristicsofHIV-relatedstigmainthehealthcaresettingacrossEuropeandCentralAsia.FindingsAtotalof18430responseswerereceivedfrom54countries,withsubstantialvariationacrosscountries(seeAnnex2).Thenumberofcountryresponsesrangedfrom1to2816responses.Tencountrieshadfewerthan50responses.Mostrespondentswerefemale(74%),morethanhalf(52%)aged25?44years,andtheyperformedavarietyofhealthcareroles,althoughthemajorityweredoctors(44%)andnurses(22%).MostrespondentswerenotawareofhavingtreatedanypersonlivingwithHIV(45%)orthenumberofpatientstreatedwaslessthanfive(27%).Only9%hadtreatedmorethan100peoplelivingwithHIVduringthepastyear.Mostrespondentsworkedinahospital(58%)butseveralotherhealthcaresettingswerealsomentioned,suchasprimarycare(17%),and18%ofrespondentsworkedininfectiousdiseaseorHIVcaredepartments.KnowledgeofHIVandtheconceptof‘undetectableequalsuntransmittable’(U=U),post-exposureprophylaxis(PEP),andpre-exposureprophylaxis(PrEP)variedacrosstypesofprofessionalrolesandhealthfacilities,withmany(69%)lackingknowledgeonkeyconceptsrelatingtoHIVtransmissionandprevention.DoctorswerethehealthcareworkerswiththehighestknowledgeconcerningHIVintheareasmeasuredinthesurvey.HealthcareworkerswhoprovidedcaretolargernumbersofpeoplelivingwithHIVreportedsubstantiallyhigherlevelsofHIVknowledge.MorethanhalfoftherespondentssaidtheywouldbeworriedwhenprovidingcaretopeoplelivingwithHIV,includingdrawingblood(57%)anddressingwounds(53%).ConcernabouttreatingpeoplelivingwithHIVwasinverselyrelatedtothelevelofHIVknowledge.Asmall,butnoticeablepercentage(8%)ofhealthcareworkersreportedthattheywouldavoidphysicalcontactandaquarter(26%)ofrespondentsreportedthattheywouldweardoublegloveswhenprovidingcaretoapersonlivingwithHIV.Similarly,asubstantialproportionofhealthcareworkersharbouredreservationsaboutprovidingcaretospecificgroupsofpeoplelivingwithHIV:12%stronglypreferrednottoprovidecaretopeoplewhoinjectdrugs,while6%stronglypreferredtoavoidprovidingcaretomenwhohavesexwithmen(MSM),sexworkers,andtransgendermenandwomen,reportedlyinfluencedbyalackoftrainingandaperceptionofincreasedrisk.WhilemanyfacilitieshadprotocolsandguidelinestoprotectagainstHIVinfectionandpreventdiscrimination,therewasstillalackofawarenessorimplementationofthesepoliciesinsomesettings.Discriminatorypracticeswerereported,with22%havingwitnessedunwillingnesstoprovidecare,19%havingwitnesseddisclosureofHIVstatuswithoutconsent,18%poorerqualityofcare,and30%discriminatoryremarksortalkingbadlyaboutpeoplelivingwithHIV.ConclusionsThereportprovidesinsightsintothelevelandcharacteristicsofHIV-relatedstigmainthehealthcaresettinginEuropeandCentralAsiaandoutlinesareasthatneedtobeaddressed.Thereportidentifiesanurgentneedforrobust,multifacetedinterventions,encompassingeducationandfacility-levelguidelinestoeliminatestigma,improveHIVknowledgeamonghealthcareworkers,andensureequitable,non-stigmatisingcareforallpeoplelivingwithHIV,ultimatelycontributingtotheglobalgoalofendingtheAIDSepidemicby2030