Predictors of TB and HIV/AIDS external stigma among healthcare workers in the Free State Province, South Africa

Abstract

𝑬𝒏𝒈𝒍𝒊𝒔𝒉 𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: HIV/AIDS and TB are heavily stigmatised diseases that negatively impact health care service delivery and treatment outcomes. While there are numerous studies investigating healthcare workers (HCWs) stigmatizing TB and HIV patients, not much research has been undertaken on HCWs stigmatizing colleagues who have/are thought to have HIV/AIDS or TB. Therefore, this study sought to describe the levels of external HIV and TB stigma and to determine the factors associated with HIV and TB stigma among HCWs towards their colleagues.

𝗠𝗲𝘁𝗵𝗼𝗱𝘀: The study utilised post-intervention data from a randomised control trial among HCWs at public hospitals in the Free State, South Africa. Of the 286 HCWs based at control hospitals who completed self-administered questionnaires, 124 were clinical professionals (doctors, nurses and allied professionals) involved in direct patient care, and 162 were administrative and support staff not directly involved in patient care. The data was analysed using descriptive statistics as well as binomial logistic regression to predict factors associated with external HIV and TB stigma.

𝗥𝗲𝘀𝘂𝗹𝘁𝘀: The results revealed more self-reported HIV stigma than TB stigma enacted towards colleagues. Slightly less than half of the respondents (47.6%) had high levels of HIV external stigma, while only one in five (20.7%) had high levels of TB external stigma. HIV external stigma was associated with a lack of personal contact with HIV-positive co-workers (AOR: 2.137, CI: 1.267-3.606, p=0.004), female gender (AOR: 2.336, CI: 1.326-4.114, p=0.003), and low to moderate HIV knowledge (AOR: 2.052, CI: 1.095-3.845, p=0.025). TB stigma was predicted by age only, with older HCWs being more stigmatising than their younger counterparts (AOR: 1.042, CI: 1.006-1.079, p=0.023).

𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: The study identified higher levels of HIV external stigma than TB external stigma among HCWs. These findings suggest that HIV and TB stigma have different origins and manifestations and that various factors, such as the modes of transmission, perceived responsibility, social implications, treatment outcomes, and historical contexts of the respective diseases, may influence them. As a result, interventions for reducing stigma in healthcare settings should be tailored to the specific characteristics and needs of each disease and its affected population. ___________________________________________________________________

𝑨𝒇𝒓𝒊𝒌𝒂𝒂𝒏𝒔 𝗔𝗴𝘁𝗲𝗿𝗴𝗿𝗼𝗻𝗱: MIV/VIGS en TB is siektes wat sterk gestigmatiseer word en 'n negatiewe impak op gesondheidsorg-dienslewering en behandelingsuitkomste het. Hoewel daar talle studies is wat ondersoek instel na gesondheidswerkers (GWs) se stigmatisering van TB- en MIV-pasiënte, is daar nie baie navorsing gedoen oor GWs wat kollegas met HIV/VIGS of TB stigmatiseer of vermoed word daarvan nie. Daarom het hierdie studie gepoog om die vlakke van eksterne MIV- en TB-stigma te beskryf en om die faktore wat verband hou met MIV- en TB-stigma onder GWs teenoor hul kollegas te bepaal.

𝗠𝗲𝘁𝗼𝗱𝗲𝘀: Die studie het na-intervensiedata gebruik van 'n gerandomiseerde kontroleproef onder GWs by openbare hospitale in die Vrystaat, Suid-Afrika. Van die 286 GWs wat aan beheerhospitale gestasioneer is en self-geadministreerde vraelyste voltooi het, was 124 kliniese professionele persone (dokters, verpleegsters en geassosieerde professionele persone) wat direkte pasiëntsorg gelewer het, en 162 was administratiewe en ondersteuningspersoneel wat nie direk betrokke was by pasiëntsorg nie. Die data is geanaliseer met behulp van beskrywende statistiek sowel as binominale logistiese regressie om faktore wat met eksterne MIV- en TB-stigma geassosieer word, te voorspel.

𝗥𝗲𝘀𝘂𝗹𝘁𝗮𝘁𝗲: Die resultate het meer selfgerapporteerde MIV-stigma as TB-stigma getoon wat teen kollegas gepleeg word. Effens minder as die helfte van die respondente (47.6%) het hoë vlakke van MIV eksterne stigma gehad, terwyl slegs een uit vyf (20.7%) hoë vlakke van TB eksterne stigma gehad het. MIV eksterne stigma is geassosieer met 'n gebrek aan persoonlike kontak met MIV-positiewe kollegas (AOR: 2.137, CI: 1.267-3.606, p=0.004), vroulike geslag (AOR: 2.336, CI: 1.326-4.114, p=0.003), en lae tot matige MIV-kennis (AOR: 2.052, p=0.025). TB-stigma is slegs deur ouderdom voorspel, met ouer GWs wat meer stigmatiserend as hul jonger eweknieë was (AOR: 1.042, CI: 1.006-1.079, p=0.023).

𝗦𝗹𝗼𝘁: Die studie het hoër vlakke van MIV eksterne stigma as TB eksterne stigma onder GWs geïdentifiseer. Hierdie bevindinge suggereer dat MIV- en TB-stigma verskillende oorspronge en manifestasies het en dat verskeie faktore, soos die oordragmetodes, waargenome verantwoordelikheid, sosiale implikasies, behandelingsoptredes en historiese kontekste van die onderskeie siektes, hulle mag beïnvloed. Gevolglik behoort ingrypings om stigmatisering in gesondheidsorgomgewings te verminder, toegespits te word op die spesifieke eienskappe en behoeftes van elke siekte en sy geaffekteerde bevolking. ___________________________________________________________________