This is an application to investigate stigma in healthcare settings in South India and to develop an intervention to reduce stigma based on the finding of the investigation. India is the most densely populated country in Asia and has over 4 million adults and children living with HIV/AIDS. As in most of the world, HIV stigma is highly prevalent in India. Such stigma inhibits access to care in India by causing patients to be reluctant to be tested or seek treatment and by leading healthcare facilities to deny care or provide inadequate care. Healthcare workers may stigmatize HIV patients and may have misconceptions about transmission of HIV, leading to fears of treating HIV patients. Healthcare workers may also fear being stigmatized for working with HIV patients. Breaches in confidentiality in healthcare settings leads to further stigmatization by staff as well as other patients and their families. Such stigmatization can be severely detrimental to the health and well-being of people living with HIV and the people around them. Although stigma is widespread, it has not been extensively studied and is, therefore, poorly understood especially in the realm of healthcare. Data are needed to inform political leadership, medical providers and the community about HIM in order to reduce stigma. The proposed project will interview people living with HIM and their families, physicians, nurses, paramedical workers, hospital administrators and managers, HIV negative patients, public policy makers, and people from the general public in four states in South India. Interviews will address how stigma is formulated, influenced, and expressed, how it affects healthcare, and how it can be reduced. Interviews will be analyzed to assess the various aspects and levels of stigmatization prevalent in South Indian communities and healthcare facilities. Results will be used to develop an intervention to reduce stigma in healthcare settings. The project principal investigator, Dr. Suniti Solomon, is the founder and director of YRG CARE. She and her colleagues were the first to detect HIV in India at Madras Medical College in 1986. YRG CARE is a non-governmental agency in Chennai, India that provides HIV care and counseling, HIV and STD testing, and HIV prevention efforts to patients in southern India. Dr. Solomon was an invited speaker at the Stigma Conference in Bethesda, Maryland, 2001.
