Reducing HIV stigma among healthcare providers in India using a partly tablet-administered intervention: the DriSti trial

ABSTRACT

HIV stigma has long been recognized as a significant barrier in the worldwide fight against HIV. Across cultures, stigma has been shown to cause psychological distress and act as a barrier to engagement in care. Health professionals can serve as a crucial source of HIV stigma, with drivers that include fears and transmission misconceptions and pre-existing negative attitudes towards marginalized groups. To increase their impact, stigma reduction interventions need to be scalable and sustainable as well as adaptable to different cultural contexts. The DriSti intervention was designed to meet these needs through an easily adaptable, mostly tablet-administered, interactive intervention delivered to ward staff (n = 1,557) and nursing students (n = 1,625) in 62 Indian institutions, using a cRCT design, with wait-list controls. Six-month outcome analyses, showed significant reductions in misconceptions (p < .001) and worry about acquiring HIV at work (p < .001). Intervention participants also reported significantly greater reductions in endorsement of coercive policies (p < .001) and in the number of situations in which they intended to discriminate against PLWH (p < .001) than control participants. This brief, scaleable intervention could be adapted for similar populations in the region, using different mHealth platforms and thus has important implications for current global stigma reduction initiatives and training curricula.

KEYWORDS:

• HIV stigma
• mHealth
• stigma intervention
• healthcare providers
• nursing students
• ward staff
• India

Acknowledgements

The authors would like to thank Radhika Kishore and Prajith M – Division of Medical Informatics, SJRI for their support of the mHealth application and data management. We acknowledge and thank the DriSti interviewers, intervention staff, and trackers for their hard work and dedication to the study participants. Special thanks are given to our PLWH co-facilitators, several of whom also served as actors in our video clips. Their courage and determination to use their voices to reduce stigma in healthcare facilities is inspiring and much appreciated. Lastly, we are grateful to all of the study participants who generously shared their time and thoughts on the sensitive topics involved in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

ORCID

Maria L. Ekstrand http://orcid.org/0000-0001-7587-2899

Additional information

Funding

This work was supported by the National Institute of Mental Health [grant number R01MH093257].