Abstract:
People living with HIV assume that healthcare workers should have adequate knowledge of HIV and have a reasonable expectation that they will be treated with compassion, acceptance and respect in the healthcare setting. Unfortunately, the medical advances in HIV treatment have far surpassed the antiquated beliefs and attitudes of some healthcare workers. The purpose of this mixed methods study was to explore the nature and extent of HIV stigma and discrimination in the healthcare setting in New Zealand as experienced by those living with HIV. It also enabled people to describe these experiences and the impact they had on their lives. A mixed methods approach with a survey research design was used, with open-ended questions on the questionnaire providing the qualitative data. Study participants were under the care of the Infectious Disease (ID) department at Auckland City Hospital and/or were members of two national HIV peer-support organisations. Data were collected from August 2012 to February 2013. The quantitative data were analysed using descriptive statistics and chi-square tests, while the qualitative data were analysed according to general inductive analysis. A total of 213 people living with HIV participated in the study. One hundred people (47%) indicated that they had experienced HIV discrimination by a healthcare worker, with 28 of these 100 documenting that discrimination had occurred within the last five years. These included breaches of confidentiality (41%), excessive infection control (40%), being treated last (25%), and being refused treatment (21%). Healthcare settings with the most complaints were GPs, dentists, non-ID hospital wards, and non-ID outpatient clinics. Qualitative themes included inappropriate comments/questions, negative attitudes, and a lack of HIV knowledge. The qualitative data also revealed that internalised and anticipated stigma led to coping strategies to avoid HIV stigma and discrimination. This study found that people living with HIV continue to experience stigma and discrimination in the healthcare setting in New Zealand, especially where knowledge of HIV was limited. This demonstrates that ongoing HIV education in the healthcare setting remains a very important facet of HIV care and should help to normalise HIV, while at the same time reduce stigma and discrimination. People living with HIV would also benefit from more counselling and peer support in order to increase self-esteem and mitigate the negative impact of stigma and discrimination.