HIV- and Drug Use-Related Stigma and Service Provision Among Community Health Workers in Vietnam.

This study compared community health workers' (CHW) stigma towards people living with HIV (PLH) and people who use drugs (PWUD) and explored the relationship between stigma and CHWs' confidence level in providing HIV/drug-related services. Using two sets of identically worded questions, levels of stigma towards PWUD and PLH were measured among 120 CHW from 60 communes in Vietnam. The associations between CHWs' confidence in service provision and stigma towards PWUD and PLH were examined using a linear mixed-effects regression model. The majority of the CHW reported higher levels of stigma towards PWUD than towards PLH. Compared to the CHW reporting higher stigma towards PWUD, those with higher stigma towards PLH were significantly less confident in service provision. Social opprobrium attached to drug-using behaviors can be a major driver behind the overall HIV stigma. CHWs' fear of HIV infection should be tackled to boost their confidence in HIV/drug-related care provision.

[1]  B. Pescosolido,et al.  Challenges and opportunities in examining and addressing intersectional stigma and health , 2019, BMC Medicine.

[2]  C. Latkin,et al.  Client and Provider Perspectives on Antiretroviral Treatment Uptake and Adherence Among People Who Inject Drugs in Indonesia, Ukraine and Vietnam: HPTN 074 , 2018, AIDS and Behavior.

[3]  N. Tuan,et al.  Efficacy of Communication Training of Community Health Workers on Service Delivery to People Who Inject Drugs in Vietnam: A Clustered Randomized Trial. , 2018, American journal of public health.

[4]  N. Tuan,et al.  Commune Health Workers' Methadone Maintenance Treatment (MMT) Knowledge and Perceived Difficulties Providing Decentralized MMT Services in Vietnam , 2018, Substance use & misuse.

[5]  Cynthia M. Lakon,et al.  A Grounded Theory Study of HIV‐Related Stigma in U.S.‐Based Health Care Settings , 2017, The Journal of the Association of Nurses in AIDS Care : JANAC.

[6]  R. Dwyer,et al.  Stigma and Self-Stigma in Addiction , 2017, Journal of Bioethical Inquiry.

[7]  J. Windle.  A Slow March from Social Evil to Harm Reduction: Drugs and Drug Policy in Vietnam , 2017 .

[8]  L. H. Nguyen,et al.  Drug addiction stigma in relation to methadone maintenance treatment by different service delivery models in Vietnam , 2016, BMC Public Health.

[9]  M. Talaat,et al.  HIV Stigma Toward People Living With HIV and Health Providers Associated With Their Care: Qualitative Interviews With Community Members in Egypt , 2016, The Journal of the Association of Nurses in AIDS Care : JANAC.

[10]  Zunyou Wu,et al.  Addressing HIV stigma in protected medical settings , 2015, AIDS care.

[11]  Michael G. Wilson,et al.  Stigma, HIV and health: a qualitative synthesis , 2015, BMC Public Health.

[12]  Stefan Baral,et al.  A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? , 2013, Journal of the International AIDS Society.

[13]  D. Bangsberg,et al.  Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis , 2013, Journal of the International AIDS Society.

[14]  E. Brouwers,et al.  Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. , 2013, Drug and alcohol dependence.

[15]  H. Lynch.  Discrimination at the doctor's office. , 2013, The New England journal of medicine.

[16]  Zunyou Wu,et al.  Reducing HIV-related stigma in health care settings: a randomized controlled trial in China. , 2013, American journal of public health.

[17]  K. Moland,et al.  Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam , 2012, BMC Health Services Research.

[18]  Stephenie R. Chaudoir,et al.  From Conceptualizing to Measuring HIV Stigma: A Review of HIV Stigma Mechanism Measures , 2009, AIDS and Behavior.

[19]  S. Kalichman,et al.  AIDS‐Related Stigma in Individuals With Other Stigmatized Identities in the USA: A Review of Layered Stigmas , 2008 .

[20]  A. Sohn,et al.  A Qualitative Study of Stigma and Discrimination against People Living with HIV in Ho Chi Minh City, Vietnam , 2008, AIDS and Behavior.

[21]  L. Maher,et al.  Scaling up HIV treatment, care and support for injecting drug users in Vietnam. , 2007, The International journal on drug policy.

[22]  H. McKenna,et al.  Illicit drug users in Northern Ireland: perceptions and experiences of health and social care professionals. , 2006, Journal of psychiatric and mental health nursing.

[23]  D. Reidpath,et al.  A method for the quantitative analysis of the layering of HIV-related stigma , 2005, AIDS care.

[24]  Paul D Cleary,et al.  Predictors and consequences of negative physician attitudes toward HIV-infected injection drug users. , 2005, Archives of internal medicine.

[25]  N. T. Hien,et al.  HIV/AIDS Epidemics in Vietnam: Evolution and Responses , 2004 .

[26]  L. Roberts,et al.  Ethical considerations in caring for women with substance use disorders. , 2003, Obstetrics and gynecology clinics of North America.

[27]  P. Aggleton,et al.  HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. , 2003, Social science & medicine.

[28]  Gregory M. Herek,et al.  AIDS and Stigma , 1999 .

[29]  E. Brouwers,et al.  [Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review]. , 2015, Tijdschrift voor psychiatrie.

[30]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[31]  D. Reidpath,et al.  Stigmatization of AIDS Patients: Disentangling Thai Nursing Students’ Attitudes Towards HIV/AIDS, Drug Use, and Commercial Sex , 2007, AIDS and Behavior.

[32]  Nhan Dan.  Constitution of the Socialist Republic of Vietnam , 1981 .