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MOPE406 - Poster Exhibition
HIV related stigma and discrimination in Bangladesh: a mixed methods exploration
T. Roy1, F.A. Alam2, F. Nabi3, S. Sultana4
1The University of Nottingham, Division for Social Research in Medicines & Health, Nottingham, United Kingdom, 2Newcastle Law Academy, Law School, Dhaka, Bangladesh, 3Singing for Life, Dhaka, Bangladesh, 4National Anti-TB Association of Bnagladesh, Dhaka, Bangladesh
Background: The aim of this mixed methods research was to explore the magnitude of individual and systemic stigma/discrimination against people living with HIV/AIDS (PLWHA) in Bangladesh in order to facilitate the development of tailor-made anti-stigma initiatives that are culturally sensitive.
Methods: We conducted a cross-sectional survey of 238 PLWHA, 69 semi-structured interviews (PLWHA-39; stakeholders-30) and 10 focus group discussions (PLWHA-4; stakeholders-6) with PLWHA and key stakeholders drawn from 3 districts in Bangladesh (Dhaka, Chittagong and Sylhet). Quantitative and qualitative data were assessed with statistical and thematic analysis, respectively, and then combined.
Results: HIV related stigma/discrimination was very common - 87% of the sample (n=238) reported stigmatized or discriminatory behaviors in last three months. Stigma/discrimination was significantly associated (p< 0.01) with HIV-disclosure, never married, not having an independent income, education, depression and poor self-esteem. Multivariate analysis revealed that the odds of stigmatized/discriminatory behaviour were higher in PLWHA if HIV status was disclosed (OR: 2.6, p< 0.01), those who did not have any independent income (OR: 5.4, P < 0.001), and who reported depression symptoms (OR: 6.8, p< 0.001). For individuals with greater exposure to stigma showed greater level of mental distress. Qualitative data confirmed the pervasive nature of stigma/discrimination across Bangladeshi society, prevailing within the general community, amongst family members, amid health care providers, and at the level of government. Such stigma appears to be fuelled by misunderstandings of HIV transmission/prevention; fears of contagion and the perceived dangerousness of HIV. Strategies suggested for reducing stigma/discrimination in Bangladesh included education campaigns involving celebrities/media people, the transformation of HIV/AIDS policy and legislation, and expanding the social and economic opportunities of the PLWHA.
Conclusion: The results from this study underscore the need for greater commitment from governments, policy-makers and program implementers in Bangladesh to reinforce HIV related stigma reduction interventions as a major public health and development issue.
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