The role of people living with HIV as patient instructors – reducing stigma and improving interest around HIV care among medical students^*

* This research was conducted at University of Toronto.

ABSTRACT

People living with HIV/AIDS (PHAs) are increasingly recognized as experts in HIV and their own health. We developed a simulated clinical encounter (SCE) in which medical students provided HIV pre- and post-test counselling and point-of-care HIV testing for PHAs as patient instructors (PHA-PIs) under clinical preceptor supervision. The study assessed the acceptability of this teaching tool with a focus on assessing impact on HIV-related stigma among medical students. University of Toronto pre-clerkship medical students participated in a series of SCEs facilitated by 16 PHA-PIs and 22 clinical preceptors. Pre- and post-SCE students completed the validated Health Care Provider HIV/AIDS Stigma Scale (HPASS). HPASS measures overall stigma, as well as three domains within HIV stigma: stereotyping, discrimination, and prejudice. Higher scores represented higher levels of stigma. An additional questionnaire measured comfort in providing HIV-related care. Mean scores and results of paired t-tests are presented. Post-SCE, students (n  = 62) demonstrated decreased overall stigma (68.74 vs. 61.81, p  < .001) as well as decreased stigma within each domain. Post-SCE, students (n  = 67) reported increased comfort in providing HIV-related care (10.24 vs. 18.06, p  < .001). Involving PHA-PIs reduced HIV-related stigma among medical students and increased comfort in providing HIV-related care.

KEYWORDS:

• Medical education
• community-based research
• HIV/AIDS
• testing and counselling
• stigma

Acknowledgements

First and foremost, we would like to thank all of the PHAs who shared their experiences and engaged in teaching with the medical students. We also extend our thanks to all of the study participants, including the medical students and the clinical preceptors. We are extremely grateful to the Patient Instructor Steering Committee, which provided guidance throughout all stages of the study and ensured that community interests were being represented. We would like to thank our key partners, the Toronto People With AIDS Foundation and the Faculty of Medicine at the University of Toronto, for ongoing support throughout the study. We would like to thank Maria Hatzipantelis and Mark Fisher at the Ontario HIV Treatment Network for their support with electronic data collection tools, as well as Hassle Free Clinic for their counseling support and supply of testing kits. Finally, we would like to acknowledge the Canadian Institutes of Health Research for funding this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

* This research was conducted at University of Toronto.

Additional information

Funding

This work was funded by the Canadian Institutes of Health Research under [grant number CBR 104070].