A total facility approach to reducing HIV stigma in health facilities: implementation process and lessons learned

Area of Science:

• Public Health
• Health Services Research
• Social Psychology

Background:

• Health facility HIV stigma impedes effective HIV response.
• Stigma manifests across client-staff, staff-staff interactions, and institutional systems.
• A multi-level, socioecological approach is necessary to address stigma comprehensively.

Purpose of the Study:

• To detail the development and implementation of a "total facility" strategy for reducing HIV stigma in healthcare settings.
• To provide a replicable model for combating health facility-associated HIV stigma in Ghana and Tanzania.

Main Methods:

• The strategy employed principles of social cognitive theory and interpersonal contact theory.
• Interventions targeted key stigma drivers: fear of transmission, awareness, attitudes, and the facility environment.
• A three-stage process involved formative research, capacity building, and integration into facility operations.

Main Results:

• The implementation yielded a structured three-stage process: formative research, capacity building, and integration.
• Key lessons included leveraging formative data, using participatory training, involving management and people with HIV, and integrating interventions into existing structures.

Conclusions:

• Reducing health facility stigma is crucial for the HIV response.
• The described "total facility" approach presents a feasible and well-accepted method for stigma reduction.