Experience of HIV-related discrimination in health-care settings
Export Indicator
Progress in reducing HIV-related discrimination experienced by people living with HIV when seeking health-care services.
Number of respondents who respond in the affirmative (“Yes”) to at least one of the seven items per question.
Number of all respondents
Numerator/denominator
People Living with HIV Stigma Index
Respondents of the study are asked if they experienced any of the following forms of HIV-related discrimination when seeking HIV and non-HIV-specific health services in the last 12 months:
- Denial of care due to HIV status.
- Advised not to have sex because of HIV status.
- Being the subject of gossip or negative talk because of HIV status.
- Verbal abuse because of HIV status.
- Physical abuse because of HIV status.
- Avoidance of physical contact because of HIV status.
- Sharing of HIV status without consent.
Every 2–3 years
Responses for each question are required, as is the consolidated response for the composite indicator. The composite indicator can be disaggregated by the following:
- Type of health service (HIV, non-HIV).
- Gender (male, female, transgender, other, prefer not to say).
- Key population (gay men or other men who have sex with men, sex workers, transgender people, people who use drugs).
- Age group (8–19 years, 20–24 years, 25–49 years, 50+ years).
- Length of time knowing HIV-positive status (0–<1 years, 1–4 years, 5–9 years, 10–14 years, or 15+ years).
The proposed indicator combines 14 items that capture discrimination experienced by people living with HIV when seeking HIV care (seven items) and non-HIV care (seven items). During the 2016 consultation process to update the People Living with HIV Stigma Index survey, people living with HIV highlighted the importance of separately measuring discrimination experienced when seeking HIV and non-HIV care. In response, the new version of the survey asks about experiences of discrimination when seeking both HIV care and non-HIV care (whereas the original survey only asked about stigma experienced when seeking health services in general). When reporting on this indicator with data from People Living with HIV Stigma Index surveys conducted prior to 2017, it will not be possible to disaggregate by the type of health service sought.
This indicator directly measures experiences of discrimination among people living with HIV who sought health services.
The recommended questions assess whether specific forms of discrimination have been experienced in a health-care setting. The experience of discrimination may be dependent on whether the health-care provider is aware of the person’s HIV status. Given this, disclosure of HIV status to the health-care provider should be collected whenever possible in order to help interpret the indicator.
In addition, people seeking HIV services at specialty HIV clinics may report fewer experiences of discrimination than people seeking HIV services that are integrated within general health-care services. Thus, capturing the type of clinic is recommended where possible. It also would be advisable to compare the findings from this indicator with Indicators 4.1 (Discriminatory attitudes towards people living with HIV) and 4.2 (Avoidance of health care among key populations) for a broader understanding of the stigma environment and the discrimination that can result in a given context.
Findings from this indicator should also be analysed in conjunction with the NCPI responses on programmes to address stigma and discrimination in health care and their scale, as well as programs to train health-care providers on human rights and medical ethics.