Gender differences in HIV related stigma among doctors in Egypt
Manal Benkirane, MD, MPHUS Naval Medical Research Unit N. 3
Benkirane, M, Lohiniva AL, Abdelrahman E, Kamal W. and Talaat M
Background
• Stigma - barrier to care for PLHA.
• Little information on gender – stigma healthcare setting.
• Studies from Thailand and Belize: female healthcare workers are more stigmatizing than males.
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Background
• MENA - Females in the general population more positive attitudes towards PLHA than males.
• No studies on gender differences and stigma in the healthcare setting in Egypt.
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Study Objectives
• To explore gender differences in stigmatizing attitudes towards PLHA among doctors in Egypt.
• To provide gender based policy recommendations for stigma reduction.
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Methods
• Cross sectional study design • 2 tertiary care hospitals in
Giza and Cairo governorates.
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MethodsN=
332
122(37%)
210 (63 %)
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Methods
• Data collection- October/December 2010
• Structured questionnaire: – Socio-demographic information– HIV related misconceptions– Stigmatizing attitudes – Intention to treat PLHA.
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Methods
• Misconceptions - percentages.
• Stigma - 3 scores developed.
• Answers coded 0 – 1.
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Methods
Category Scale Cronbach Alpha
Fear based stigma 12 items .53
Value based stigma 9 items .71
Intention to treat PLHA 4 items .86
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Methods
• Stigma scores standardized to 10 for comparison purposes.
• Chi square and t- test.
• Linear regression – stigma scores.
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Results
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Results
1. Background characteristics of study participants2. Misconceptions about HIV transmission3. Stigmatizing attitudes towards PLHA4. Intention to treat PLHA
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Background characteristics
• No significant differences in terms of education, age, religion, working experience and training on HIV. – Most participants > 45 years– 25% doctors worked abroad– 12% received previous HIV training– 90% were Muslims
• Significant difference in origin – 60% females from capital city
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Gender & HIV misconceptions
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Gender & stigma scores
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Gender & intention to treat PLHA
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PLHA IDU* PLHA SW* PLHA Child*
Male Doctors
Female Doctors
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Gender & fear based stigma by age group
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Gender & value based stigma by age group
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Gender & intention to treat PLHA by age group
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Linear regressionFear based stigmar2= 0.216
Value based stigma r2= 0.179
Intention to treatr2= 0.168
B P value B P value B P value
Constant -2.342 0.000 -1.930 0.000 -0.076 0.873
Sex •Male •Female
Ref-0.516
0.040Ref- 0.988
0.015
Previous HIV training •No •Yes
Ref0.846
0.001Ref0.775
0.037
Fear based 0.36 0.008
Value based 0.230 0.000 0.466 0.000
Origin •Cairo•Outside Cairo
Ref-0.643
0.009
Post Graduate studies•No•Yes
Ref -0.749
0.003
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Linear Regression
• Sex - significant predictor of value based stigma and intention to treat PLHA .
• Origin and education level were significant predictors of value based stigma.
• Previous HIV training and value based stigma was significant predictors for fear based stigma.
• Doctors with high value stigma score were more resistant to treat PLHA.
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Conclusions
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HIV related misconceptions
>Social norms
CultureAccess to
information
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Fear based stigma
>Social norms
Limited access to information
Fear of infection
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Value based stigma
>Conservativenes
s
Moral judgments about the
disease
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Refusal to treat PLHA
>Value driven multilayered?
Resistance to deal with PLHA
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Recommendations
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Recommendations
• Need to prioritize and encourage women’s involvement in HIV training and education.
• Need to use a socio-cultural framework when addressing fear and value based stigma among female healthcare workers in Egypt.
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Recommendations
• Emotional invoking strategies could be used in stigma reduction among females.
• Need to address stigma towards key populations at higher risk of infection.
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Recommendations
• Need to explore other factors influencing female doctors’ willingness to treat PLHA.
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Acknowledgements
• National AIDS Program, Egypt• Global AIDS Program, Centers for Disease Control,
Atlanta, US• Om El Masryeen and Monira hospital management
and teams.• Ford Foundation
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Questions?
Background characteristicsMale Doctors
N= 210Female Doctors
N = 122P Value
Origin Cairo 41.1% 60.3% .001*
Other 58.9% 39.7%
Age group 25-34 45.7% 39.7% .206
35-44 11.0% 14.0%
45 + 43.3% 46.3%
Religion Muslim 93.8% 91.0% .338
Christian 6.2% 9.0%
Training outside Egypt 13.3% 9.0% .239
Working abroad 25.2% 23.0% .640
Previous HIV training 11.4% 11.5% .990
Hospital Om El masryeen 59.5% 58.2% .813
Monira 40.5% 41.8%
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