@article{30680,
  keywords = {Tanzania, Stigma, Namibia, Kenya, Infection Control, HIV, Health care workers, Discrimination, Africa},
  author = {Straetemans M and Bakker M I and Mitchell E M H},
  title = {Correlates of observing and willingness to report stigma towards HIV clients by (TB) health workers in Africa.},
  abstract = {<p><strong>SETTING: </strong>Health care facilities in Kenya, Tanzania and Namibia.</p>

<p><strong>OBJECTIVE: </strong>To study the factors associated with the observation of and willingness to report stigmatising behaviour towards persons living with the human immunodeficiency virus (HIV) among health care workers (HCWs).</p>

<p><strong>DESIGN: </strong>Mixed-effect logistic regression analyses of 9516 HCW interviews, including those of 4062 (43%) TB workers carried out as part of the Service Provision Assessments (SPAs) between 2006 and 2010.</p>

<p><strong>RESULT: </strong>Discrimination (i.e., enacted stigma) was observed by respectively 1042 (60%), 384 (40%) and 907 (69%) TB workers in Kenya, Namibia and Tanzania, similar to the trend observed among all HCWs. Observations of discrimination were clustered at facility level in Kenya, and mapping of facility-level discrimination suggested geographic clustering. HCWs were more likely to observe discrimination in facilities without regular supportive supervision (adjusted OR [aOR] 2.33, 95%CI 1.09-4.96). No HCW characteristics were found to predict intention to report. Training in patients' rights and in confidentiality predisposed HCWs to recognise discrimination (aOR 2.51, 95%CI 1.19-5.28) and the willingness to report it (aOR 2.23, 95%CI 1.11-4.47). Exposure to training in TB infection control (IC) was associated with greater willingness to report discrimination (aOR 2.13, 95%CI 1.03-4.39).</p>

<p><strong>CONCLUSION: </strong>Supervision and exposure to training in patient's rights and confidentiality improved HCWs' understanding and advocacy of dignified and respectful TB-HIV care. All HCWs are equally likely to be allies, agents of change and amplifiers of an anti-stigma message, and broad engagement is required. Innovative approaches to reduce discrimination-while ensuring proper IC-should be explored.</p>
},
  year = {2017},
  journal = {The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease},
  volume = {21},
  pages = {6-18},
  issn = {1815-7920},
  url = {http://tinyurl.com/yd34utkc},
  doi = {10.5588/ijtld.16.0913},
  language = {eng},
}