With timely diagnosis and access to effective treatment, HIV is now a chronic, manageable condition with normal life expectancy.

However, HIV stigma is widely recognised as being a major determinant of HIV health because it delays diagnosis (for example, it can lead to people avoiding testing, or clinicians may feel uncomfortable discussing testing with their patients) and impedes connection with care, treatment and support.^1,2,3

People with HIV think carefully about sharing their HIV status and balance the potential benefit of disclosure with the risk of harm.  Healthcare settings are places where people with HIV may choose to share their HIV status, but they can also be the places where stigma, discrimination and privacy breaches are more likely to occur. Among a recent large sample of Australian people with HIV, 30% reported being treated differently by a healthcare worker in the previous 12 months.⁴

Nurses, midwives and allied health workers have few opportunities for professional development or reflective practice about HIV and may have had limited experience working with HIV-positive people.

Let’s Talk about HIV (Stigma) is a new eight-minute reflective practice video and learning resource that has been developed by HIV peer organisation Living Positive Victoria and the HIV Nursing Program at Bolton Clarke.

Most healthcare workers would not intentionally behave negatively toward people with HIV,⁵ but this video recognises that individual healthcare workers aren’t always sure how to respond or what to do if a patient discloses their HIV status.

Let’s Talk About HIV (Stigma) offers accessible tips and friendly non-judgemental guidance for healthcare workers about good communication and how to provide safe care to people with HIV.  Using a Q&A format, this video features real people with HIV and healthcare workers having a cup of tea and an Iced-VoVo while discussing safe environments, good practice, allyship, and the importance of having a basic up-to-date knowledge of HIV.

The video is designed to provide healthcare workers a short and accessible learning opportunity about HIV and invite them to commit to updating their HIV knowledge and reflecting on their practice. The accompanying learning resource also offers a 1.5-to-2-hour self-directed CPD learning activity, with targeted learning objectives and reflective practice questions.

The video and learning resource can also be used within teams to generate discussion about issues in providing quality care for people with HIV including appropriate questions, privacy protections and standard precautions. 

What can healthcare workers do to ensure that HIV stigma doesn’t get in the way of good quality care?

There are simple ways healthcare workers can create a supportive and welcoming environment for people with HIV.

People with HIV are not required to share their HIV status when accessing your health service, and they usually choose not to if it is not relevant to their care.

Most people with HIV have experienced discrimination, intrusive questions about their HIV and incorrect infection control practices in healthcare settings.

Only share HIV status in notes or at handover if relevant to the person’s immediate clinical care or treatment.

Take care to only ask questions about HIV if clinically relevant, or relevant to the person’s immediate care.

Be reassured that standard precautions are all you need when caring for people with HIV, even when you are doing wound care or exposed to blood or body fluids.⁶

Update your HIV knowledge – don’t rely on patients to do this for you.

Being an HIV ally can make a huge difference to people’s access to healthcare.

To watch the video and access the learning resource visit https://lpv.org.au/reports-and-resources/resources-for-health-community-workers/lets-talk-about-hiv-stigma/

References

1 Mendonca CJ, Newton-John TRO, Alperstein DM, et al. Quality of Life of People Living with HIV in Australia: The Role of Stigma, Social Disconnection and Mental Health. AIDS Behav. 2023;27:545-57. doi: 10.1007/s10461-022-03790-7.

2 Gutiérrez M, Brooks-Hawkins J, Hassan K, et al. Relationship of health rating and HIV-related stigma among people living with HIV: a community study. Humanit Soc Sci Commun. 2022;9:98. doi: 10.1057/s41599-022-01086-8.

3 Chambers, L.A., Rueda, S., Baker, D.N. et al. Stigma, HIV and health: a qualitative synthesis. BMC Public Health 15, 848 (2015). https://doi.org/10.1186/s12889-015-2197-0

4 Norman T, Power J, Rule J, Chen J, Bourne A. HIV Futures 10: Quality of life among people living with HIV in Australia. Monograph series number 134. Australian Research Centre in Sex, Health and Society, La Trobe University; 2022. doi: 10.26181/21397641

5 Broady T, Brener L, Cama E, Hopwood M, Treloar C. Stigma Indicators Monitoring Project: Summary Report for Healthcare Workers, 2021. Sydney: Centre for Social Research in Health, UNSW Sydney; 2022. Available from: https://www.unsw.edu.au/content/dam/pdfs/unsw-adobe-websites/arts-design-architecture/ada-faculty/csrh/2022-01-stigma-indicators-summary-hcw-2021.pdf

6 National Health and Medical Research Council. Australian Guidelines for the Prevention and Control of Infection in Healthcare. Canberra: Commonwealth of Australia; 2019.

Authors:

Jen Johnson BA, Programs Manager, Living Positive Victoria, Melbourne Victoria

Liz Crock AM PhD, MPH, BSc, Grad Dip Ed, RN, AACRN (Advanced AIDS Certified Registered Nurse), Certificate in Infectious Diseases Nursing (Fairfield Hospital), HIV Nurse Practitioner, Bolton Clarke HIV Program, Bolton Clarke Homeless Persons Program, Port Melbourne Victoria