The presentation did in the 11th ICAAP in the Satellite session 08 (Hall G) on Getting to Zero Discrimination in Healthcare Setting in Asia organized by International Labour Organization (ILO) 11th ICAAP was held in the Queen Sirikith Convention Centre, Bangkok, Thailand from 18-22 November 2013.

1. Sri Lankan Experience
HIV Stigma Reduction Interventions for
Healthcare Workers

2. Introduction
• Stigma has often been associated with disfiguring or
incurable diseases, in particular diseases that society
perceives to be caused by the violation of social
norms, including those that sanction sexual
behaviour.
• HIV/AIDS is a good example of this type of disease
(Crandall and Moriarty 1995)

3. Introduction to stigma
• Societal labeling of and individual or group as different or deviant
because of a “discrediting attribute” (Goffman 1963)
• HIV/AIDS is a good example of this type of disease (Crandall and
Moriarty 1995)
More Recently;
• Stigma has been defined as a dynamic process that is linked to
competition for power and tied into existing social mechanism of
exclusion and dominance (Link and Phelan 2001)
• Social process that involves identifying and using “differences”
between groups of people to create and legitimize social hierarchies
and inequalities (Parker and Aggleton 2002)

4. UNAIDS defines HIV-related stigma and
discrimination as:
• A ‘process of devaluation’ of people either living with
or associated with HIV and AIDS
• Discrimination follows stigma and is the unfair and
unjust treatment of an individual based on his or her
real or perceived HIV status.

5. stigma and discrimination are major “road blocks” to universal
access to HIV prevention, treatment, care and support
Reduce an individual’s
willingness to
• Practice prevention
• Seek HIV testing
• Disclose his or her HIV
status to others
• Ask for (or give) care and
support
• Begin and adhere to
treatment

6. Range of stigma and discrimination
Enacted Stigma (stigma in action)
stigma
Gossip,
Isolation
Rejection
Blaming
Insult
Ignore
Not talking
Not listening
Unlawful acts such
as
Dismissal from
employment;
Refusal from
healthcare
Chasing from
home/village
Discrimination

7. How to measure stigma

8. Recommended Indicators and Questions are
Segmented into Three Populations
1. Community (different tools)
2. Health care workers (20-item stigma index used
in Sri Lanka)
3. People living with HIV/AIDS (PLHIV Stigma Index
collaborative effort of GNP+, ICW, IPPF, and
UNAIDS)

9. Baseline assessment of stigma
among HCWs against PLHIV
in Sri Lanka
20-item Stigma Index
Test-20 stigma index
(T20 stigma index)

10. Study Setting
National Hospital of Sri Lanka
Castle Street Hospital for
Women
De Soysa Maternity Hospital
National STD/AIDS Control
Programme
Lady Ridgeway Hospital for Children
Base Hospital, Angoda

11. 20-item Stigma Index among HCWs
• Design – Cross sectional descriptive
study
• Population – Healthcare workers in
six major tertiary care institutions in
Colombo.
• Sample - A convenience sample of
832 healthcare workers.
–
–
–
–
–
130 physicians
205 nurses
92 medical laboratory technicians
154 attendants and
251 labourers.
• Data collection tools - A stigma
index was developed aimed at
quantifying levels of stigma
among health workers against
PLHIV.
• The internal consistency of the
scale was 0.711 (Cronbach’s
alpha).
• Responses to the stigma index
were scaled using the Likert scale:
*Agree (1), Can’t say (2), Disagree
(3)].
• The Index scores ranged from 20
to 60.
• Higher scores indicated higher
levels of stigma. The data was
analysed using SPSS v16.

12. 20-item stigma index
• The median age of the sample was 41 years (SD, 10.6
years).
• The healthcare workers surveyed had an average of
15 years of work experience in their respective jobs.
• Over 60% had provided care to an HIV-positive
patient.
• The median score for the stigma index was 38.3 (46%
in percentage scale) and ranged from 36 to 40 (40%50% as a percentage).

14. Poster
presentation
Poster was presented
at the 11th ICAAP in
2013 from 18-22
November 2013 at
Queen Sirikith
Convention Centre,
Bangkok, Thailand

16. Stigma Reduction Intervention
Two-day, activity based workshop
Main components of the intervention were
1.
2.
Welcome and pre-test
Introduction to the workshop
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Expectations activity (Group work and presentation)
Character Card activity (Res and roles of characters in a household)
Understanding the HIV situation (Lecture discussion)
Natural History of HIV infection (Lecture discussion)
Introduction to HIV stigma and discrimination (Lecture discussion)
Problem tree activity (cause and effect)
Agree, Disagree activity (exploring thoughts)
Recognizing our own communication (Stigmatizing or non-stigmatizing)
PLHIV testimonials and group discussions
Risk card activity (understanding the personal and professional risk)
Standard precautions (Lecture discussion)
HIV testing models (Lecture discussion)
15.
Post-test and closing

20. Effectiveness of the intervention in Reducing
the Stigma and Discrimination
• The Welcome2care (W2C) tool showed significant
improvements in stigma reduction among the
nurses from initial 76% to post-training result of
89% using Wilcoxon Signed rank Test (p=0.001)
• This finding was consistent in other workshops
carried out.
• This shows the effectiveness of peer pressure on
changing the attitudes.

21. Poster
presentation
Poster was presented
at the 11th ICAAP in
2013 from 18-22
November 2013 at
Queen Sirikith
Convention Centre,
Bangkok, Thailand