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      Stigma in health facilities: why it matters and how we can change it


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          Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge—both approaches and methods—regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development’s Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.

          The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.

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          Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review.

          Healthcare professionals are crucial in the identification and accessibility to treatment for people with substance use disorders. Our objective was to assess health professionals' attitudes towards patients with substance use disorders and examine the consequences of these attitudes on healthcare delivery for these patients in Western countries. Pubmed, PsycINFO and Embase were systematically searched for articles published between 2000 and 2011. Studies evaluating health professionals' attitudes towards patients with substance use disorders and consequences of negative attitudes were included. An inclusion criterion was that studies addressed alcohol or illicit drug abuse. Reviews, commentaries and letters were excluded, as were studies originating from non-Western countries. The search process yielded 1562 citations. After selection and quality assessment, 28 studies were included. Health professionals generally had a negative attitude towards patients with substance use disorders. They perceived violence, manipulation, and poor motivation as impeding factors in the healthcare delivery for these patients. Health professionals also lacked adequate education, training and support structures in working with this patient group. Negative attitudes of health professionals diminished patients' feelings of empowerment and subsequent treatment outcomes. Health professionals are less involved and have a more task-oriented approach in the delivery of healthcare, resulting in less personal engagement and diminished empathy. This review indicates that negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care for these patients. However, few studies have evaluated the consequences of health professionals' negative attitudes towards patients with substance use disorders. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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            Combating HIV stigma in health care settings: what works?

            The purpose of this review paper is to provide information and guidance to those in the health care setting about why it is important to combat HIV-related stigma and how to successfully address its causes and consequences within health facilities. Research shows that stigma and discrimination in the health care setting and elsewhere contributes to keeping people, including health workers, from accessing HIV prevention, care and treatment services and adopting key preventive behaviours. Studies from different parts of the world reveal that there are three main immediately actionable causes of HIV-related stigma in health facilities: lack of awareness among health workers of what stigma looks like and why it is damaging; fear of casual contact stemming from incomplete knowledge about HIV transmission; and the association of HIV with improper or immoral behaviour. To combat stigma in health facilities, interventions must focus on the individual, environmental and policy levels. The paper argues that reducing stigma by working at all three levels is feasible and will likely result in long-lasting benefits for both health workers and HIV-positive patients. The existence of tested stigma-reduction tools and approaches has moved the field forward. What is needed now is the political will and resources to support and scale up stigma-reduction activities throughout health care settings globally.
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              The fight against stigma: an overview of stigma-reduction strategies and interventions.

              In many health conditions, people are severely affected by health-related stigma and discrimination. A literature review was conducted to identify stigma-reduction strategies and interventions in the field of HIV/AIDS, mental illness, leprosy, TB and epilepsy. The review identified several levels at which interventions and strategies are being implemented. These are the intrapersonal, interpersonal, organizational/institutional, community and governmental/structural level. Although a lot of work has been carried out on stigma and stigma reduction, far less work has been done on assessing the effectiveness of stigma-reduction strategies. The effective strategies identified mainly concentrated on the individual and the community level. In order to reduce health-related stigma and discrimination significantly, single-level and single-target group approaches are not enough. What is required is a patient-centred approach, which starts with interventions targeting the intrapersonal level, to empower affected persons to assist in the development and implementation of stigma-reduction programmes at other levels.

                Author and article information

                Roger.McLean@sta.uwi.edu , rmcleanuwi@yahoo.com
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                15 February 2019
                15 February 2019
                : 17
                : 25
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                [2 ]ISNI 0000000122483208, GRID grid.10698.36, Epidemiology Department, , UNC Gillings School of Global Public Health, ; 2103 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599 USA
                [3 ]ISNI 0000 0004 0425 469X, GRID grid.8991.9, Department of Global Health and Development, Faculty of Public Health and Policy, , London School of Hygiene and Tropical Medicine, ; London, UK
                [4 ]GRID grid.478091.3, School of Medicine, Zambart, ; P.O. Box 50697, Lusaka, Zambia
                [5 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Division of Prevention Science, , University of California, San Francisco, ; 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549 USA
                [6 ]ISNI 0000 0004 1794 3160, GRID grid.418280.7, St John’s Research Institute, St John’s National Academy of Health Sciences, ; Bengaluru, India
                [7 ]GRID grid.430529.9, Health Economics Unit, Centre for Health Economics, Faculty of Social Sciences, , University of the West Indies, St. Augustine Campus, ; St. Augustine, Trinidad and Tobago
                [8 ]ISNI 0000000092621349, GRID grid.6906.9, International Institute for Social Studies, , Erasmus University, ; Kortenaerkade 12, 2518 AX The Hague, Netherlands
                [9 ]ISNI 0000 0004 1936 9174, GRID grid.16416.34, University of Rochester School of Nursing, ; 601 Elmwood Avenue, Box SON, Rochester, NY 14642 USA
                [10 ]GRID grid.415502.7, Centre for Urban Health Solutions, , Li Ka Shing Knowledge Institute, St. Michael’s Hospital, ; 209 Victoria Street, Toronto, M5T 1B8 Canada
                [11 ]ISNI 0000 0001 2157 0406, GRID grid.7870.8, Departments of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, , Pontificia Universidad Católica de Chile, ; Santiago, Chile
                [12 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Clinical Public Health Division, Dalla Lana School of Public Health, , University of Toronto, ; Ontario, Canada
                [13 ]ISNI 0000 0000 8793 5925, GRID grid.155956.b, Office of Transformative Global Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), ; Ontario, Canada
                [14 ]ISNI 0000 0004 0576 2573, GRID grid.415836.d, Department of Disease Control, , Ministry of Public Health of the Government of Thailand, ; Tivanond Road, Nonthaburi, 11000 Thailand
                [15 ]ISNI 0000000106344187, GRID grid.265892.2, Department of Health Care Organization and Policy, Maternal and Child Health Concentration, School of Public Health, , University of Alabama at Birmingham, ; Birmingham, USA
                [16 ]ISNI 0000000106344187, GRID grid.265892.2, Behavioral and Community Sciences Core, UAB Center for AIDS Research (CFAR), ; Birmingham, USA
                [17 ]ISNI 0000 0001 0790 3681, GRID grid.5284.b, Centre for Longitudinal & Life Course Studies, , University of Antwerp, ; Sint-Jacobstraat 2, B-2000 Antwerp, Belgium
                [18 ]ISNI 0000 0001 2284 638X, GRID grid.412219.d, Centre for Health Systems Research & Development, , University of the Free State, ; PO Box 399, Bloemfontein, 9300 South Africa
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                : 3 July 2018
                : 8 January 2019
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                © The Author(s) 2019

                stigma,discrimination,reduction,intervention,programs,health facilities
                stigma, discrimination, reduction, intervention, programs, health facilities


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