HIV stigma in healthcare settings: need for increased knowledge among healthcare workers and improved facility-level guidelines

The European Centre for Disease Prevention and Control (ECDC) and the European AIDS Clinical Society (EACS) have released a report assessing HIV-related stigma and discrimination within healthcare settings in Europe and Central Asia, revealing significant gaps in knowledge on HIV transmission and prevention among healthcare workers. This lack of knowledge is associated with higher levels of stigma and discrimination against people living with HIV, hampering efforts to reach the Sustainable Development Goal of Ending AIDS by 2030.

One in four healthcare workers lacked knowledge on the concept of "undetectable equals untransmittable" (U=U) which means that people with HIV who achieve and maintain an undetectable viral load cannot sexually transmit the virus to others. Forty-four percent lacked knowledge on post-exposure prophylaxis (PEP), and almost sixty percent lacked knowledge on pre-exposure prophylaxis (PrEP). Less than a third of the respondents had correct knowledge on all three statements concerning HIV transmission and prevention.

Teymur Noor, ECDC HIV expert and coordinator of the study. said:

“There is a pressing need for robust, multifaceted interventions, encompassing education and facility-level guidelines to eliminate stigma, improve HIV knowledge among healthcare workers, and ensure equitable, non-stigmatising care for all people living with HIV. Addressing these issues is essential to achieving the global goal of ending the AIDS epidemic by 2030."

A small but notable percentage of healthcare workers (8%) reported that they would avoid physical contact, and a quarter said they would wear double gloves when providing care to a person living with HIV.

Some healthcare workers also expressed reservations about providing care to key populations at higher risk of HIV, such as people who inject drugs, men who have sex with men, sex workers or transgender individuals. These attitudes were reportedly influenced by a lack of training and a perception of increased risk.

Despite the presence of protocols and guidelines to protect against HIV infection and prevent discrimination in many facilities, there was still a substantial lack of awareness or implementation of these policies in some settings. Discriminatory practices were also reported, with more than one in five respondents having witnessed unwillingness to provide care to people living with or at risk for HIV. Additionally, almost one third of those surveyed observed discriminatory remarks or negative comments about people living with HIV and nearly twenty percent witnessed disclosure of HIV status without consent and.

These findings are particularly important as HIV stigma is linked to negative healthcare outcomes such as delayed care, avoidance of health facilities, and poor adherence to medication, ultimately hampering HIV prevention and treatment efforts.

Understanding how and in which contexts HIV stigma manifests in healthcare settings is necessary in order to intervene and address individual and institutional drivers of stigma and discrimination towards people living with HIV.

The report is part of ECDC’s ongoing work to assess progress of the implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia through a series of thematic reports and evidence briefs. 

Findings from the report will also be presented at the 25th International AIDS Conference in Munich, Germany, on 26 July 2024.