China has 1 million Persons Living with HIV (PLH) with the rate rising exponentially over the last five years. Yunnan Province represents the largest portion of China's HIV epidemic, primarily among injecting drug users. While undocumented systematically, substantial experience with other stigmatizing disorders and anecdotal accounts document that HIV-related stigma is high and impedes effective responses for prevention and care in China. This application addresses HIV-related stigma among health care providers in Yunnan Province. Stigma is defined as a multidimensional construct with sociocultural, structural, and interpersonal determinants; providers' stigmatizing attitudes and behaviors can be influenced by educating providers about HIV-related policies and providing access to implement the policies, training providers over time to be knowledgeable about transmission and how to protect themselves, acceptance of PLH, and diffusing positive messages to peers. It is anticipated that providers' attitudes and behaviors will influence health care delivery to PLH. A collaborative research team from the Chinese Center for Disease Control and the UCLA Center for Community Health will implement a 3-year investigation among health providers and administrators in Yunnan Province in 3 phases. Phase 1 will consist of qualitative interviews regarding HW-related experiences, stigma, barriers and facilitators of care to PLH, and assessment measures for these concepts with: 1) 20 PLH and 10 of their family members; 2) 20 service providers; and 3) 20 health service administrators, with the addition of questions focused on HIV-related policies and procedures. Phase 2 will consist of a survey of 900 service providers and administrators in Yunnan Province on the prevalence and sources of HIV-related stigma. Using the results from the initial phases, an intervention will be developed and pilot tested with 50 service providers and evaluated using a comparison group of 50 providers over 6-months. The goals of the intervention will be to reduce stigmatizing attitudes towards PLH and diffusion of positive messages about PLH from service providers, education on HIV-related policies and access to resources to implement HW testing, universal precautions, and HIV treatment and care (using current Chinese standards of care). These data will prepare the team to conduct a randomized controlled trial across different levels of health care providers in China.
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