Stigma-associated attitudes and practices among Romanian clinical providers

Objectives

People living with HIV/AIDS today expect a typical lifespan, although many continue to encounter psychological and societal challenges, including stigma and discrimination. In healthcare settings, this may manifest as refusal of care or treatment, non-consensual testing, confidentiality breaches, and unfavourable attitudes, among other issues. We sought to better understand stigma-related beliefs and practices within the Romanian clinician community.

Methods

We designed an analytical cross-sectional study to measure potentially stigmatizing clinical practices and to identify training gaps that could help alleviate stigma. We conducted a 17-question survey that was distributed online to healthcare providers in Moldova, the North-Eastern Romanian region, via the WhatsApp platform, between 1 August and 30 September 2023.

Results

A total of 139 healthcare providers participated in the survey: 71.9% physicians, 23.7% nurses, and 4.3% other providers (e.g., psychologists, pharmacists) working in the fields of infectious disease (36.0%), primary care (13.7%), internal medicine (22.3%), and other specialties such as obstetrics-gynaecology or paediatrics (18.0%). Most participants indicated that they were not worried about providing care to someone living with HIV/AIDS, most were hesitant to perform HIV testing because they feared the patient's response, and most indicated that co-workers were hesitant to work alongside a colleague with HIV. In total, 31.7% of participants reported no stigmatizing attitudes or practices, 18.7% reported one stigmatizing attitude or practice, 32.4% reported two, and 17.3% reported three or more. After controlling for confounders, not having an HIV discrimination policy in place and not having been trained on HIV-related confidentiality were significantly predictive of holding one or more stigmatizing attitudes or practices.

Conclusions

The policy context—particularly anti-discrimination workplace policies and provider training on HIV-related confidentiality—is an important determinant of HIV-related stigmatizing practices and attitudes in Romania.