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ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 5  |  Page : 675-681

Factors associated with HIV/AIDS-related stigma and discrimination by medical professionals in Korea: A survey of infectious disease specialists in Korea


1 Department of Preventive Medicine, Inha University College of Medicine, Incheon, Republic of Korea
2 Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
3 Department of Research, Women with Disabilities Empathy, Seoul, Republic of Korea
4 Department of Research, Korean Network of People Living with HIV/AIDS, Seoul, Republic of Korea
5 Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea

Date of Acceptance06-Feb-2019
Date of Web Publication15-May-2019

Correspondence Address:
Dr. D H Kim
Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
Republic of Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_440_17

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   Abstract 


Objectives: This study sought to identify factors associated with this discrimination by medical professionals in Korea. Subjects and Methods: This study was a cross-sectional survey. We conducted web-based surveys against infectious disease specialists and infectious disease nurse. We evaluated the frequency of human immunodeficiency virus (HIV)/AIDS-related discrimination by medical professionals by health service type on the 5-point scale. We identified the association between several factors and HIV/AIDS-related stigma and discrimination by medical professionals on the 5-point scale. Results: A total of 81 experts, 57 infectious disease specialists (approximately 27% of all infectious disease specialists in Korea) and 24 infectious disease nurse practitioners, participated in this study. The frequency of stigma and discrimination increased significantly when invasive treatment included both outpatient and inpatient services (both P < 0.05). Medical professional's preconceptions, fear of infection, and lack of knowledge have an association with HIV/AIDS-related stigma and discrimination by medical professionals. Conclusion: HIV/AIDS-related stigma and discrimination by medical professionals in Korea might be associated with factors related to the fear of medical professionals.

Keywords: Acquired immunodeficiency syndrome, discrimination, HIV


How to cite this article:
Lee H J, Kim D H, Na Y J, Kwon M R, Yoon H J, Lee W J, Woo S H. Factors associated with HIV/AIDS-related stigma and discrimination by medical professionals in Korea: A survey of infectious disease specialists in Korea. Niger J Clin Pract 2019;22:675-81

How to cite this URL:
Lee H J, Kim D H, Na Y J, Kwon M R, Yoon H J, Lee W J, Woo S H. Factors associated with HIV/AIDS-related stigma and discrimination by medical professionals in Korea: A survey of infectious disease specialists in Korea. Niger J Clin Pract [serial online] 2019 [cited 2019 May 27];22:675-81. Available from: http://www.njcponline.com/text.asp?2019/22/5/675/258275




   Introduction Top


The average life expectancy of patients with human immunodeficiency virus (HIV) has been close to the normal population after the introduction of antiretroviral therapy (ART).[1] In addition, with ART, it has been possible to reduce the spread of the virus to others.[2] According to recent UNAIDS data covering 160 countries, 1.1 million AIDS-related deaths and 2.1 million new infections worldwide occurred in 2015, which decreased significantly from 2.8 million deaths and 5.4 million new infections seen in the year 2000.[3]

However, changes in the rates of HIV infection in Korea differ from the global trend. Despite the increasing effectiveness of prevention and treatment, new HIV infections continue to increase rapidly. Korea's first HIV/AIDS case was observed in 1985. After that, new infections gradually increased; in 1999, the number of individuals living with HIV reached 1,000 with new infections increasing rapidly thereafter. In 2007, this number exceeded 5,000 and there was a total of 12,523 patients in 2015.[4]

In 2015, 94.1% of all registered individuals living with HIV are reported to be on medication.[4] In addition, all registered individuals living with HIV face minimal economic barriers to treatment because of government economic support through the national health insurance system in Korea.[5] Therefore, the increasing trend of new HIV infections is likely to be less associated with low rate of treatment or economic accessibility and may be associated with other factors.

Discrimination related to HIV/AIDS is one of the most important causes of failure to control HIV infection.[6] Unfortunately, medical professionals are often reported as one of the most significant source of discrimination related to HIV/AIDS.[7] In Korea, in contrast to the global trend, the trend of new HIV infections' increase continuously may be associated with HIV/AIDS-related stigma and discrimination by medical professionals.[8]

Stigma related to HIV infection by medical professionals who treat those with HIV can lead to undesirable consequences such as fear, anger, disgust, and denial of treatment to individuals living with HIV. These attitudes can affect the health services provided by medical professionals. And these attitudes can deprive patient's right to health also.[9] Reducing stigma associated with HIV infection can improve the quality of services provided to individuals living with HIV and patient mental health.[10] For that reason, we sought to identify factors associated with HIV/AIDS-related stigma and discrimination by medical professionals in Korea.


   Subjects and Methods Top


Study design: Cross-sectional survey

Study setting

In Korea, a total of 11,504 people have been infected with HIV during the past 30 years, of whom 10,630 (92.4%) are men. The sex ratio trend has remained similar over the past 30 years. The sex ratio, which was 10.2 in the late 1980s, declined slowly to 8.4 in the early 1990s. However, the sex ratio was increased again after the year 2000, and increased to 12.2 in 2015. Since 2006, there have been no infections caused by transfusions, only sexually transmitted infections.[4] Considering this, it can be assumed that men who have sex with men are at highest risk of HIV infection and transmission in Korea.

In 2005, the Korea Center for Disease Control and Prevention launched a hospital-based HIV/AIDS consultation project to improve the quality of life of individuals living with HIV and to prevent new HIV infections.[11] Since then, a significant number of individuals living with HIV have been treated at the hospital where the project is conducted. As of 2015, a total of 19 hospitals are undergoing hospital-based HIV/AIDS consultation projects, and a total of 22 professional counselor nurses are active in these hospitals.[4]

Prior to 2005, when the hospital-based HIV/AIDS consultation project began, individuals living with HIV chose hospitals based on their own judgment when using hospitals for HIV treatment and other medical needs. Therefore, it was frequent that they were treated at different hospitals according to their medical needs. However, recently individuals living with HIV tend to be treated after consultation with a counseling nurse for most of their medical needs. As a result, individuals living with HIV tend to be naturally treated in the same hospital for all their medical needs, including HIV treatment. Along with these changes, it has been generalized that a considerable number of individuals living with HIV are being treated continuously for a period of several years by the same infectious disease specialist.[12]

Study population

We tried to survey the experience of an infectious disease specialist and infectious disease nurse practitioners who had referred other medical professionals to treat various symptoms of individuals living with HIV. For this reason, the population of this study were infectious disease specialists who were belonging to the Korean Society for AIDS and infectious disease nurse practitioners who work with infectious disease specialists. A list of infectious disease specialists and infectious disease nurse practitioners was obtained from the Korean Society for AIDS. The study included infectious disease specialists and infectious disease nurse practitioners who agreed to participate in this study. To study only infectious disease specialists and infectious disease nurse practitioners who regularly treat individuals living with HIV, physicians with other specialties were excluded from this study.

Data collection

A predesigned questionnaire was used to collect data. We emailed the entire study population to explain the purposes of the study and request their participation. We conducted web-based surveys including infectious disease specialists and infectious disease nurse practitioners who agreed to participate in this study. The questionnaires used in this study were developed by a total of six people including two KNP+ (Korean Network of People living with HIV/AIDS) activists, two consulting doctors, one lawyer, and one human rights activist. The questionnaire consisted of three parts that asked about personal characteristics of respondents, the frequency of discrimination according to the type of health service, and the difference in associations of discrimination by medical professionals between HIV infection and other health conditions. The developed questionnaire was supplemented through consultation with two infectious disease specialists including the chairman of the Korean Society for AIDS.

We used the 5-point scale score to determine the frequency of HIV/AIDS-related stigma and discrimination, by type of health service. We classified health services into four types: outpatient care services, outpatient services related to invasive treatment, inpatient care services, and inpatient care services related to invasive treatment. In our study, invasive treatment was defined as a treatment that could spread HIV during procedure. We also used the 5-point scale score to determine the frequency of HIV/AIDS-related stigma and discrimination, by type of department. We asked the department where HIV/AIDS-related stigma and discrimination by medical professionals occur most frequently. These questions allowed duplicate answers.

To compare the associations of discrimination, we selected health conditions and compared them with HIV infection. The five health conditions, we compared with HIV infection, were hepatitis B virus (HBV) infection, influenza H1N1 infection, schizophrenia, Down's syndrome, and hypertension. The association factors of the discrimination by medical professionals were selected through focus group interviews of six medical professionals including two KNP+s consulting doctors, two counseling nurses, and two infectious specialists. The top five factors by frequency were used in this study. The selected factors were medical professional's preconceptions, fear of infection and lack of knowledge, complaints and opposition from other patients, lack of economic incentives, and insufficient support of healthcare system. We used the 5-point scale score to evaluate each factor's association.

Statistical analysis

The results of the questionnaires were coded by the two study assistants and they verified whether their coding matches. The data collected in this study were statistically analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 19 from IBM (Chicago, IL, USA). In this study, categorical variables were presented as frequency and percentage, and numerical variables were presented as mean and standard deviation. We used Chi-square test for the comparative analysis of categorical variables. We used Mann–Whitney U test for the comparative analysis of numerical variables. P < 0.05 was considered statistically significant.

Ethical considerations

Data were collected through the Internet anonymously by a survey service. The data collected were used for study purposes only. This study was approved by the Institutional Review Board of The Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. The approval number was OC16QISI0151.


   Results Top


A total of 57 infectious disease specialists (approximately 27% of all infectious disease specialists in Korea) and 24 infectious disease nurse practitioners participated in this study. Of these, 28 were male and 53 were female. The media age was 38 (35–43) years. In all, 21 participants had less than 10 years of experience treating individuals living with HIV, and 60 had more than 10 years. The type of hospital in which the specialists worked was a general hospital for 29 and a tertiary referral hospital for 52. The location of hospital in which the respondents worked was Seoul or the surrounding area for 59 and other area for 22. When asked whether the environment of HIV treatment in Korea is appropriate, 29 responded that the environment was appropriate, but 52 responded that the environment was inappropriate [Table 1].
Table 1: Characteristics of respondents by perception of HIV treatment environment

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By healthcare service type, there was a difference in the 5-point scale scores for frequency of discrimination. For services that include invasive treatment, the frequency of HIV/AIDS-related stigma and discrimination increased significantly [Table 2]. By healthcare service type, there was a difference in departments with frequent HIV/AIDS-related stigma and discrimination by medical professionals also [Table 3].
Table 2: The 5-point scale score for the frequency of HIV/AIDS-related stigma and discrimination

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Table 3: The top three departments with frequent HIV/AIDS-related stigma and discrimination

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In HIV infection, the 5-point scale scores to evaluate each factor's association were as follows: 4.47 points for fear of infection and lack of knowledge, 4.46 points for medical professional's preconceptions, 4.32 points for complaints and opposition from other patients, 3.59 points for insufficient support of healthcare system, and 3.15 points for lack of economic incentives. The 5-point scale scores in HBV, influenza H1N1 infection, schizophrenia, Down's syndrome, and hypertension were as shown in figures [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6].
Figure 1: The 5-point scale score for each association factor in HIV infection

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Figure 2: The 5-point scale score for each association factor in hypertension

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Figure 3: The 5-point scale score for each association factor in HBV infection

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Figure 4: The 5-point scale score for each association factor in influenza H1N1 infection

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Figure 5: The 5-point scale score for each association factor in schizophrenia

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Figure 6: The 5-point scale score for each association factor in Down's syndrome

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   Discussion Top


This is the first study to survey physicians treating individuals living with HIV regarding HIV/AIDS-related stigma and discrimination in Korean hospitals and the first study of factors associated with HIV/AIDS-related stigma and discrimination by medical professionals in Korea as well. There have been a few previous studies on more general HIV/AIDS-related stigma and discrimination.[13] But there have been no previous studies on HIV/AIDS-related stigma and discrimination by medical professionals in Korea. Therefore, we sought to determine the current state of HIV/AIDS-related stigma and discrimination by medical professionals in Korea through surveys of infectious disease specialists with experience in HIV infection treatment. In addition, based on the characteristics of the medical environment in Korea, where infectious disease specialists act as the agents of individuals living with HIV in hospitals, we asked infectious disease specialists about the situation of individuals living with HIV in the hospital. We conducted a web-based survey of infectious disease specialists.

As of 2015, the total number of infectious disease specialists in Korea was 211, of which 147 were members of the Korean Society for AIDS. In all, 57 members of the Korean Society for AIDS participated in this study. This was 38.8% of the total members of the Korean Society for AIDS, which was a relatively low participation rate. This low participation rate appears to be due to insufficient public relations for this study. This is supported by the fact that 59 of the total 81 participants worked in hospitals located in Seoul and the surrounding area. That is, the participation rate when we asked for participation directly was higher than when we asked for participation using e-mail.

In this study, despite the expectation that the frequency of discrimination would vary by healthcare service type, there were no significant differences. However, the frequency of discrimination increased significantly when invasive treatment was included in healthcare services. This could reflect the characteristics of blood-borne infectious diseases, in that medical professionals may fear contracting healthcare-associated infections during invasive treatment, and this fear could increase the frequency of discrimination against individuals living with HIV.

The results regarding which departments were most frequently associated with discrimination by medical professionals were similar. In both the outpatient and inpatient care services, the department where discrimination by medical professionals occurred most frequently was internal medicine. These results seem to reflect the characteristics of individual living with HIV who must regularly visit the department of internal medicine due to HIV infection treatment. In other words, the frequency of visits and the frequency of discrimination were proportional. However, when healthcare services included invasive treatment, the frequency of discrimination was not related to the type of service or frequency of visits. The frequency of discrimination was higher in departments providing relatively more invasive treatment. Medical professionals' fear of healthcare-associated infections likely affected the occurrence of discrimination against individuals living with HIV.

We set five items as the major association factors of discrimination by medical professionals. We questioned the impact of these five items on discrimination using the 5-point scale in six health conditions, including HIV infection. In the case of hypertension, lack of economic incentives was the major association factor of discrimination by medical professionals. In the case of influenza H1N1 infection, complaints and opposition from other patients was the major association factor of discrimination by medical professionals. In the case of Down's syndrome, insufficient support of healthcare system was the major association factor of discrimination by medical professionals. In contrast, in the case of HBV infection, schizophrenia, and HIV infection, fear of infection and lack of knowledge was the major association factor of discrimination by medical professionals. These results were similar to our expectations.

However, the degree of contribution of these association factors to discrimination by medical professionals was very different. In the case of HIV infection, the 5-point scale score for determining the effects of discrimination by medical professionals was 4.32 for fear of infection and lack of knowledge. These results were 1.4 times higher than for schizophrenia. However, despite the similarity of the infection route, the same score was 2.7 times higher than that seen for HBV infection. This trend is expected to be due to differences in the prevalence of HIV and HBV infections in Korea.

There have been a few previous studies on how the prevalence of infectious diseases has affected healthcare professionals' attitudes toward infectious disease patients. Based on a study in Malawi, healthcare professionals had a high level of knowledge of HIV/AIDS and attitudes were mostly positive, but their level of knowledge for HBV and HCV was relatively low and attitudes toward hepatitis were considered negative.[14] Despite the similar study design, these findings contrast with the results of our study. These differences are expected to be due to differences in prevalence rates of HIV and HBV. In Malawi, the highest HIV and HBV prevalence for medical inpatients is 76.1% and 17.5%, respectively.[15] In contrast, in Korea, the prevalence of HBV and HIV for the general population is 3.01% and 0.02%, respectively.[16] Considering these results, it is likely that an increasing prevalence of infectious disease will reduce the incidence of discrimination against the same disease during treatment.

There have been numerous previous studies on how the knowledge of healthcare professionals about infectious diseases has affected their attitudes toward infectious disease patients. Medical professionals who have a good knowledge of influenza H1N1 have shown a more positive attitude and a lower level of anxiety.[17] In others, lack of knowledge about HBV infection contributed significantly to negative attitudes toward patients suffering from HBV infection and had a significant impact on the quality of patient care and the relationship between physicians and patients.[18] The results of this study could be interpreted as indicating similar trends. The lack of knowledge of medical professionals related to HIV infection is expected to contribute to discrimination by medical professionals in Korea.

Despite its significance as the first study to survey HIV/AIDS-related stigma and discrimination by medical professionals in Korea, this study has several limitations. First, the study population was quite small. An additional larger study including various healthcare professionals is needed. Second, this study was a survey, not an empirical study of medical records. Surveys can be influenced by the subjectivity of the respondents. Third, the participation rates in the survey were low among the study population. Low participation rates can be associated with selection bias. Therefore, to identify the frequency of discrimination more accurately and to avoid selection bias, an objective quantitative study of medical records is needed.


   Conclusion Top


HIV/AIDS-related stigma and discrimination by medical professionals in Korea was associated with factors related to the fear of medical professionals. The frequency of discrimination increased significantly in healthcare services including invasive treatment. The fear of infection and lack of knowledge had an association with HIV/AIDS-related stigma and discrimination by medical professionals. Seminars and the workshops providing knowledge of HIV treatment are needed. Education and the publicity reducing the fear of healthcare services related infections are needed too.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Hogg R, Lima V, Sterne J, Grabar S, Battegay M, Bonarek M, et al. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: A collaborative analysis of 14 cohort studies. Lancet 2008;372:293-9.  Back to cited text no. 1
    
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Biswas B, Spitznagel E, Collier AC, Gelman BB, McArthur JC, Morgello S, et al. Characterizing HIV medication adherence for virologic success among individuals living with HIV/AIDS: Experience with the CNS HIV antiretroviral therapy effects research (CHARTER) cohort. J HIV AIDS Soc Serv 2014;13:8-25.  Back to cited text no. 2
    
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Jin H, Hampton Atkinson J, Yu X, Heaton RK, Shi C, Marcotte TP, et al. Depression and suicidality in HIV/AIDS in China. J Affect Disord 2006;94:269-75.  Back to cited text no. 10
    
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Kang CR, Bang JH, Cho SI, Kim KN, Lee HJ, Ryu BY, et al. Suicidal ideation and suicide attempts among human immunodeficiency virus-infected adults: Differences in risk factors and their implications. AIDS Care 2016;28:306-13.  Back to cited text no. 13
    
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Jin H, Hampton Atkinson J, Yu X, Heaton RK, Shi C, Marcotte TP, et al. Depression and suicidality in HIV/AIDS in China. J Affect Disord 2006;94:269-75.  Back to cited text no. 14
    
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Nyirenda M, Beadsworth MB, Stephany P, Hart CA, Hart IJ, Munthali C, et al. Prevalence of infection with hepatitis B and C virus and coinfection with HIV in medical inpatients in Malawi. J Infect 2008;57:72-7.  Back to cited text no. 15
    
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Mishra P, Bhadauria US, Dasar PL, N S, Kumar S, Lalani A, et al. Knowledge, attitude and anxiety towards pandemic flu a potential bio weapon among health professionals in Indore City. Przegl Epidemiol 2016;70:41-5.  Back to cited text no. 17
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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