Assessment Of Healthcare Providers And Clients’ Perspectives On Hiv/ Aids Stigma And Discrimination In Public Health Facilities In Anambra State

INTRODUCTON

1.1 Background to the Study

Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) pandemic remains a significant public health challenge globally, with Nigeria being one of the countries heavily affected by the epidemic. Anambra State, located in southeastern Nigeria, has a high burden of HIV/AIDS cases, requiring effective healthcare services to address the needs of affected individuals. However, despite advancements in HIV/AIDS management and prevention, stigma and discrimination against people living with HIV/AIDS (PLWHA) persist, hindering access to healthcare services and impeding the overall response to the epidemic.

HIV/AIDS-related stigma and discrimination have been persistent challenges in the global response to the epidemic. Stigma refers to negative attitudes, beliefs, and behaviors directed towards individuals or groups based on their HIV status, while discrimination involves unfair treatment or exclusion due to HIV status (Herek, Capitanio, & Widaman, 2003). These forms of social exclusion have severe consequences for people living with HIV/AIDS (PLWHA) and can impede efforts to control the epidemic.

Numerous studies have documented the prevalence of HIV/AIDS-related stigma and discrimination in various settings. In a study conducted in South Africa, 45% of PLWHA reported experiencing stigma in healthcare settings (Greeff et al., 2008). Similarly, a study in Tanzania found that 62% of PLWHA experienced stigma and discrimination when accessing healthcare services (Nyblade et al., 2019). In Nigeria, research conducted in different regions has consistently shown high levels of stigma and discrimination against PLWHA (Adeyemi et al., 2015; Ezedinachi et al., 2017).

The effects of HIV/AIDS-related stigma and discrimination are far-reaching and have significant implications for the health and well-being of PLWHA. Stigma and discrimination contribute to delayed HIV testing, as individuals fear the social consequences associated with a positive diagnosis (Mahajan et al., 2008). This delay in testing further hinders early access to treatment and care, leading to increased morbidity and mortality rates (Mak et al., 2007). Moreover, stigma and discrimination have been linked to poor adherence to antiretroviral therapy (ART), a critical component of HIV/AIDS management. A study conducted in Uganda found that HIV-related stigma significantly predicted non-adherence to ART (Wouters et al., 2008). The fear of being stigmatized or discriminated against can undermine individuals' motivation to adhere to their treatment regimen, resulting in treatment failure and the development of drug resistance (Roura et al., 2009). Psychologically, stigma and discrimination exacerbate the psychosocial burden of living with HIV/AIDS. PLWHA often experience feelings of guilt, shame, and self-blame as a result of societal attitudes and behaviors (Simbayi et al., 2007). This can lead to social isolation, depression, anxiety, and decreased quality of life (Earnshaw et al., 2013; Turan et al., 2017).

This study aims to assess the perspectives of both healthcare providers and clients regarding HIV/AIDS-related stigma and discrimination in public health facilities in Anambra State

1.2 Statement of Research Problem

The HIV/AIDS epidemic is now a global crisis, and constitutes one of the most formidable challenges to organisation’s growth. HIV/AIDS-related discrimination remains a pressing issue that significantly affects the health and well-being of individuals living with HIV/AIDS (PLWHA). This study aims to explore the effects of discrimination on PLWHA in three key areas: access to healthcare, adherence to treatment, and psychosocial well-being. Discrimination against PLWHA leads to various barriers in accessing healthcare services. Negative attitudes and behaviors from healthcare providers can result in delayed diagnosis, inadequate treatment, and suboptimal care for PLWHA (Earnshaw et al., 2013). Moreover, stigma and discrimination create an environment of fear and shame, discouraging individuals from seeking HIV testing and counseling services (Mahajan et al., 2008). These barriers to accessing healthcare services not only compromise individual health outcomes but also hinder efforts to control the spread of HIV/AIDS.

Discrimination experienced by PLWHA also has a significant impact on treatment adherence. The fear of being stigmatized or discriminated against can lead to non-disclosure of HIV status, making it challenging for individuals to maintain consistent adherence to antiretroviral therapy (ART) regimens (Wouters et al., 2008). Inadequate adherence to treatment can result in treatment failure, increased viral load, and the development of drug resistance (Roura et al., 2009). Thus, addressing discrimination is crucial to ensure that PLWHA can effectively manage their condition and achieve positive health outcomes.

Discrimination associated with HIV/AIDS can have profound psychosocial consequences for PLWHA. Stigmatizing attitudes and behaviors contribute to feelings of shame, guilt, and self-blame, which can lead to social isolation, depression, anxiety, and decreased quality of life (Simbayi et al., 2007; Turan et al., 2017). The psychosocial impact of discrimination encompasses not only the individual but also extends to their families, communities, and broader social networks. Thus, addressing discrimination is essential for promoting the overall well-being and social inclusion of PLWHA.

This research topic will contribute to addressing the problem of discrimination against PLWHA by providing a comprehensive understanding of its effects on access to healthcare, treatment adherence, and psychosocial well-being. By exploring the perspectives of healthcare providers and clients on HIV/AIDS-related discrimination in public health facilities in Anambra State, Nigeria 

1.3 Purpose of the Study

The primary purpose of this study is to assess the perspectives of healthcare providers and clients on HIV/AIDS-related stigma and discrimination in public health facilities in Anambra State. Specifically, the study aims to:

1. To examine the impact of healthcare workers and patients' reactions to the disclosure of HIV/AIDS status on the level of status anxiety experienced by patients’ s living with HIV/AIDS.

2. To assess the degree of stigmatization and discrimination faced by  patients living with HIV/AIDS.

3. To evaluate the existing policies and program guidelines in Nigeria that address HIV/AIDS-specific issues and problems, with a particular focus on their adequacy and effectiveness in public health facilities in Anambra State.

1.4 Research Hypothesis

To achieve the research objectives, the following hypothesis were formulated;

1. Hypothesis 1:

• Ho: Non-disclosure of HIV/AIDS status (HIV positive) in Nigeria public health facilities is not dependent on the perceived fears of healthcare workers and patients' reaction.

• Ha: Non-disclosure of HIV/AIDS status (HIV positive) in Nigeria organizations is dependent on the perceived fear of healthcare workers and patients' reaction.

2. Hypothesis 2:

• Ho: Disclosure of HIV/AIDS status (HIV positive) in public health facilities does not often lead to stigmatization and discrimination in Nigeria.

• Ha: Disclosure of HIV/AIDS status (HIV positive) in organizations often leads to stigmatization and discrimination in Nigeria.

3. Hypothesis 3:

• Ho: Policies and program guidelines do not exist in public health facilities for addressing HIV/AIDS-specific issues in Nigeria.

• Ha: Policies and program guidelines exist in public health facilities for addressing HIV/AIDS-specific issues in Nigeria.

1.5 Significance of Study

This study holds several significant implications for policy, practice, and research. Firstly, it will provide insights into the nature and extent of HIV/AIDS-related stigma and discrimination experienced by healthcare providers and clients in public health facilities in Anambra State. The findings will inform the development of evidence-based interventions and policies to address these issues comprehensively.

Secondly, by exploring the factors contributing to stigma and discrimination, the study will contribute to a deeper understanding of the underlying causes and dynamics of this problem. This knowledge can guide the implementation of targeted educational programs and training for healthcare providers, aiming to reduce stigma and discrimination in healthcare settings.

Lastly, the study's recommendations will serve as a valuable resource for policymakers, healthcare managers, and stakeholders involved in HIV/AIDS care and support services in Anambra State. It will provide practical strategies to improve the quality of care, enhance access to services, and promote a supportive environment for PLWHA in public health facilities.

1.6 Limitations

This study acknowledges several limitations that may influence the generalizability of the findings. First, the study focuses solely on public health facilities in Anambra State, potentially limiting the transferability of the results to other regions or healthcare settings. Additionally, the study is subject to biases inherent in self-reported data, such as social desirability bias or recall bias.

Furthermore, the research design, which employs qualitative and quantitative methods, may have some inherent limitations. While qualitative methods allow for in-depth exploration of experiences and perceptions, the sample size may restrict the generalizability of the findings. On the other hand, quantitative methods provide larger sample sizes but may not capture the nuances and contextual factors associated with stigma and discrimination.

1.7 Scope of Study

This study focuses on public health facilities in Anambra State, Nigeria. It includes both healthcare providers and clients, aiming to capture a comprehensive understanding of HIV/AIDS-related stigma and discrimination from multiple perspectives. The study will employ a mixed-methods approach, combining qualitative interviews and quantitative surveys to gather rich and diverse data.

1.8 Operational Definition of Terms

HIV –: Acronym for the Human Immunodeficiency Virus, the cause of AIDS (acquired immunodeficiency syndrome).

AIDS –: AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a serious condition that weakens the body's immune system, leaving it unable to fight off illness. When the immune system is missing one or more of its components, the result is an immunodeficiency disorder. AIDS is an immunodeficiency disorder.

Virus –: A microscopic organism often causing diseases.

HIV positive –: A state of being diagnosed as having the human immunodeficiency virus.

Discrimination–: Is used in this code in accordance with the definition given in the Discrimination (Employment and Occupation) Convention, 1958 (No. 111), to include HIV status. It also includes discrimination on the basis of a worker’s perceived HIV status, including discrimination on the ground of sexual orientation.

Social Security –: State assistance to the poor and unemployed or welfare services provided by the State, public health facilities in areas of education, health, and housing etc.

Stigmatization – brand as unworthy or disgraceful

AIDS-related stigma and discrimination -: Refers to prejudice, negative attitudes, abuse and maltreatment directed at people living with HIV and AIDS.

Alienation –: Alienation is the process whereby people become foreign to the world they are living in, estrangement from the objective world, as through indifference or disaffection, state of being an outsider or the feeling of being isolated, as from society.