Stigma and discrimination have been obstacles to care and support services in the context of HIV/AIDS. In the current study, stigmatization was highest for the extra precaution scale followed by the fear of work-related HIV transmission (%SM
52.3). These scores were above the standardized mean (50), indicating some evidences of stigmatization and discrimination.
Healthcare providers who had high basic HIV knowledge had lower stigma scores when compared to those healthcare providers with low basic HIV knowledge. In addition, healthcare providers having in-depth HIV knowledge had lower scores as compared to those healthcare providers who did not have in-depth HIV knowledge. These findings are in agreement with the findings of other studies done elsewhere
Similarly, healthcare providers who had attended training on topics related to stigma and discrimination had lower stigma scores when compared to those healthcare providers who had not attended the trainings. This finding is in agreement with previous studies, which indicated that formal HIV/AIDS training is significantly associated with less stigmatization and discrimination
When stigma scores were compared by educational level categories, those healthcare providers with first degree and higher educational level had lower stigma scores when compared to those healthcare providers with diploma and lower educational level. This finding is supported by the findings of Tanzania Stigma Field Test Group; by the study conducted by the USAID/Health Policy Initiative, Task Order 1; and by the study conducted in Bangladesh
But it is not in agreement the findings of Vyas et al and Li et al, which indicated that medical professionals with more years of education are more likely to discriminate against PLHIV
Those healthcare providers with high HIV case load had lower stigma scores when compared to those healthcare providers with low HIV case load. This finding is in agreement with the study done in Barbados and with the study conducted by USAID/Health Policy Initiative, Task Order 1
In our study, a unit increment in the perception of policy-related institutional support had reduced the lack of feelings of safety by an average of 0.13 units. The perception of policy-related institutional support was also negatively correlated with the fear of work-related HIV transmission (r
0.05). These findings are supported by the study of Andrewin and Chien
The lack of specific policies or clear guidance related to the care of clients with HIV reinforces discriminatory behaviour amongst healthcare providers
]. Even though Ethiopia has laws and regulations that protect PLHIV against discrimination
], in the current study, the perception of policy-related institutional support was low. Key-informants from health centers also stated that there was no special policy that protects PLHIV against discrimination. The key informants also said that there was no special support for healthcare providers working with PLHIV. In addition, all of them denied the existence of anti-discrimination policy and a separate training related to stigma and discrimination for healthcare providers. This underscores the need to focus on clearly communicating anti-stigma and anti-discrimination regulations to healthcare providers and the need for enacting them.
In our study, the perception of supply-related institutional support significantly reduced stigma scores. In addition, in the qualitative part of our study, the shortage of materials and supplies was pointed as the cause of conflicts between PLHIV and healthcare providers. Other studies also showed that the lack of protective and treatment materials favor discriminatory practices and attitudes
]. In the study by Sadow et al, significantly, more healthcare providers were willing to give an injection or set up an infusion if gloves were worn than if there were no gloves
]. Moreover, the findings of our study are in agreement with the study conducted in China, which showed that the more institutional support healthcare providers were perceived to have, the less discrimination intent they would exhibit against PLHIV
The study by Reis et al indicated that healthcare providers who reported working in facilities that did not always practice universal precautions against HIV transmission were more likely to favor restrictive policies towards PLHIV
]. In our study, key informants from health centers said HIV-related protocols (including precaution protocol) are available only to those healthcare providers who had taken the respective trainings. The copies of these protocols had not been availed to each healthcare provider except that they find them with their efforts. This can create a gap in healthcare practices. Furthermore, the lower perception of protocol-related institutional support was a significant predictor of unethical treatment of PLHIV, value-driven stigma, unofficial disclosure and the lack of feelings of safety. Therefore, availing these protocols can also contribute to the reduction of stigma and discrimination against PLHIV through the increment of the perception of institutional support.
In disclosure dimension of stigma and discrimination, the healthcare providers who claimed to be very religious had significantly higher stigma scores when compared to those healthcare providers who claimed to be non-religious (p
0.01). And, those healthcare providers who claimed to be somewhat religious had significantly higher stigma scores when compared to those healthcare providers who claimed to be non-religious. The stigma score measured by unethical treatment scale also varied with perceived religiousness. The healthcare providers who claimed to be very religious had higher stigma scores when compared to those healthcare providers who claimed themselves as non-religious (p
0.01). These findings are in agreement with the findings of Andrewin and Chien and with the study conducted in Bangladesh
]. This indicates that healthcare providers share not only stigmatizing attitude related to their occupation, but also the stigmatizing attitude present in their communities.
It was noted that healthcare providers unofficially disclose the HIV sero-status of clients in order to facilitate the healthcare given to the clients and to “ensure that healthcare providers take extra precautions while dealing with HIV-positive clients”
. Similar claims were made to justify unofficial discloser of sero-status by healthcare providers in an earlier study from India
Designation of some phrases to PLHIV was also reported to be common amongst the healthcare providers in the study area. Besides, healthcare providers have failed to involve PLHIV in the care and support activities related to HIV. Involvement of PLHIV in these activities has been reported improve empowerment of the PLHIV and the probability of contact with healthcare providers. This contributes to the reduction of negative attitudes towards PLHIV
In the current study, both method and person triangulations were employed, which has increased the credibility and richness of the findings. However, it has to be noted that the findings of this study mainly reflect situation in the district healthcare settings (district hospitals and health centers) of Ethiopia. Therefore, the findings should be interpreted with caution. Replicability of the findings should be checked through further study at different levels of the health system. The responses might have been liable to social desirability bias, which might under estimate the level of stigma and discrimination. However, the use of self-administered questionnaire and replacement of names of the healthcare providers with codes were both helpful to minimize this problem.