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    Apr 11, 2021
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    Refused and referred-persistent stigma and discrimination against people living with HIV/AIDS in Bihar: a qualitative study from India

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    Authors
    Nair, M
    Kumar, P
    Harshana, A
    Kazmi, S
    Pandey, S
    Burza, S
    Moreto-Planas, L
    Issue Date
    2019-11-25
    Submitted date
    2019-12
    
    Metadata
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    Journal
    BMJ Glob Health
    Abstract
    OBJECTIVES: This study aimed to explore barriers to accessing care, if any, among people living with HIV/AIDS (PLHA) in two districts of Bihar. We also aimed to assess attitudes towards PLHA among healthcare providers and community members. DESIGN: This qualitative study used an exploratory study design through thematic analysis of semistructured, in-depth interviews. SETTING: Two districts were purposively selected for the study, namely the capital Patna and a peripheral district located approximately 100 km from Patna, in order to glean insights from a diverse sample of respondents. PARTICIPANTS: Our team purposively selected 71 participants, including 35 PLHA, 10 community members and 26 healthcare providers. RESULTS: The overarching theme that evolved from these data through thematic coding identified that enacted stigma and discrimination interfere with each step in the HIV care continuum for PLHA in Bihar, India, especially outside urban areas. The five themes that contributed to these results include: perception of HIV as a dirty illness at the community level; non-consensual disclosure of HIV status; reliance on identifying PLHA to guide procedures and resistance to universal precautions; refusal to treat identified PLHA and referrals to other health centres for treatment; and inadequate knowledge and fear among health providers with respect to HIV transmission. CONCLUSIONS: The continued presence of discriminatory and stigmatising attitudes towards PLHA negatively impacts both disclosure of HIV status as well as access to care and treatment. We recognise a pressing need to improve the knowledge of HIV transmission, and implement universal precautions across all health facilities in the state, not just to reduce stigma and discrimination but also to ensure proper infection control. In order to improve treatment adherence and encourage optimal utilisation of services, it is imperative that the health system invest more in stigma reduction in Bihar and move beyond more ineffective, punitive approaches.
    Publisher
    British Medical Journal BMJ
    URI
    http://hdl.handle.net/10144/619546
    DOI
    10.1136/bmjopen-2019-033790
    PubMed ID
    31772110
    Language
    en
    ISSN
    2044-6055
    ae974a485f413a2113503eed53cd6c53
    10.1136/bmjopen-2019-033790
    Scopus Count
    Collections
    HIV/AIDS

    entitlement

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