Reducing HIV-related stigma in health care settings: a randomized controlled trial in China

Abstract

Objectives: The objective of the intervention was to reduce service providers' stigmatizing attitudes and behaviors toward people living with HIV.

Methods: The randomized controlled trial was conducted in 40 county-level hospitals in 2 provinces of China between October 2008 and February 2010. Forty-four service providers were randomly selected from each hospital, yielding a total of 1760 study participants. We randomized the hospitals to either an intervention condition or a control condition. In the intervention hospitals, about 15% of the popular opinion leaders were identified and trained to disseminate stigma reduction messages.

Results: We observed significant improvements for the intervention group in reducing prejudicial attitudes (P < .001), reducing avoidance intent towards people living with HIV (P < .001), and increasing institutional support in the hospitals (P = .003) at 6 months after controlling for service providers' background factors and clinic-level characteristics. The intervention effects were sustained and strengthened at 12 months.

Conclusions: The intervention reduced stigmatizing attitudes and behaviors among service providers. It has the potential to be integrated into the health care systems in China and other countries.

Figures

FIGURE 1—

Flow of study participants: White Coat, Warm Heart Intervention Trial; Yunnan and Fujian Provinces, China; October 2008–February 2010.

FIGURE 2—

Plots of means (±2 SE) over time for (a) prejudicial attitude, (b) avoidance intent, and (c) institutional support: White Coat, Warm Heart Intervention Trial; Yunnan and Fujian Provinces, China; October 2008–February 2010.