gender differences in hiv related stigma among doctors in egypt

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.

XIX International AIDS Conference 2012

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.


Study Objectives

• To explore gender differences in stigmatizing attitudes towards PLHA among doctors in Egypt.

• To provide gender based policy recommendations for stigma reduction.


Methods

• Cross sectional study design • 2 tertiary care hospitals in

Giza and Cairo governorates.


MethodsN=

332

122(37%)

210 (63 %)


Methods

• Data collection- October/December 2010

• Structured questionnaire: – Socio-demographic information– HIV related misconceptions– Stigmatizing attitudes – Intention to treat PLHA.


Methods

• Misconceptions - percentages.

• Stigma - 3 scores developed.

• Answers coded 0 – 1.


Methods

Category Scale Cronbach Alpha

Fear based stigma 12 items .53

Value based stigma 9 items .71

Intention to treat PLHA 4 items .86


Methods

• Stigma scores standardized to 10 for comparison purposes.

• Chi square and t- test.

• Linear regression – stigma scores.


Results


Results

1. Background characteristics of study participants2. Misconceptions about HIV transmission3. Stigmatizing attitudes towards PLHA4. Intention to treat PLHA


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


Gender & HIV misconceptions


Gender & stigma scores


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


Gender & fear based stigma by age group


Gender & value based stigma by age group


Gender & intention to treat PLHA by age group


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


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.


Conclusions


HIV related misconceptions

>Social norms

CultureAccess to

information


Fear based stigma

>Social norms

Limited access to information

Fear of infection


Value based stigma

>Conservativenes

s

Moral judgments about the

disease


Refusal to treat PLHA

>Value driven multilayered?

Resistance to deal with PLHA


Recommendations


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.


Recommendations

• Emotional invoking strategies could be used in stigma reduction among females.

• Need to address stigma towards key populations at higher risk of infection.


Recommendations

• Need to explore other factors influencing female doctors’ willingness to treat PLHA.


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



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%


gender differences in hiv related stigma among doctors in egypt

Documents

gender stigma scores

gender intention

gender value based stigma

hiv related stigma

gender hiv misconceptions

egypt gender differences

gender fear

stigma reduction