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Effectiveness of national scale-up of HIV stigma and discrimination reduction in health facilities in Ghana
D.F. Manuel1, E. Bonku2, R. Killian2, P. Perchal3, M. Pavin4, P. Preko5, O. Aglah2, R. Akai-Nettey2, P. Ampofo2, L. McGough6
1EngenderHealth, Monitoring Evaluation and Research, Middletown, United States, 2EngenderHealth, Quality Health Partners Project, Accra, Ghana, 3EngenderHealth, HIV/STI, New York, United States, 4EngenderHealth, Monitoring Evaluation and Research, New York, United States, 5EngenderHealth, Quality Health Partners Project, New York, United States, 6Consultant, Accra, Ghana
Background: Fear of HIV-related stigma and discrimination deters people from proven prevention technologies, HIV testing, disclosing a positive result (including to intimate partners) and HIV treatment and support services. Stigma reduction is recognized as a key structural approach to the HIV response. To promote universal access to HIV services, EngenderHealth's Quality Health Partners (QHP) project scaled-up a stigma reduction initiative at care and treatment centers across Ghana. This intervention included training providers on stigma reduction and infection control, and use of quality improvement processes to address stigma.
Methods: An assessment of this initiative was conducted from November-December 2008, using quantitative and qualitative methods, including interviews of health workers and clients; interviews with informants from affected communities (FSW, MSM and PLHIV); analysis of problem statements within quality improvement action plans; and a review of stigma reduction trainings results. In all, 63 respondents were interviewed, and 16 facilities´ action plans were reviewed.
Results: Stigma reduction training among providers showed a marked increase in knowledge and positive attitudes. Moreover, the majority of clients (85%) reported that HIV stigma no longer negatively impacts the quality of care and client satisfaction in HIV-care units, but remains a problem in other healthcare departments. Most clients (87%) report overall satisfaction with HIV services, specifically friendliness and attitudes of staff. Additionally, 15 of the 16 (94%) HIV service units addressed stigma reduction in their quality improvement action plans.
Conclusions: Our findings demonstrate that an effective stigma reduction approach can contribute to reversing stigmatizing attitudes and discriminatory practices in health facilities, and create an enabling environment for affected communities to seek HIV services. Efforts are now needed to raise awareness among government officials and the media about the role stigma reduction plays in achieving universal access, and the importance of integrating this into a comprehensive HIV response.
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