Health Facility Staff: Attitudes and Opinions (Tier 1)

Export Indicator

Percent of health facility staff that hold stigmatizing views about people living with HIV.
What it measures

It measures value-driven stigma (stereotyping and prejudices) that health facility staff have towards patients living with HIV.


An individual-driver of HIV stigma and discrimination in healthcare settings is attitudes and opinions of health facility staff towards patients living with HIV. Measuring stereotypes and prejudices toward people living with HIV among healthcare workers is important because values and attitudes may (1) affect whether a provider treats patients with dignity, which healthcare options are offered to a patient, which individuals are offered testing, and when they are offered testing and how; and (2) lead to inaccurate risk assessment.


Number of health facility staff who agree with any of the first 3 statements or disagree with the fourth statement


Number of all health facility staff who answered at least one statement


Numerator / Denominator

Method of measurement

Any type of facility-based surveys, e.g. Service Provision Assessment or Quality Assurance Surveys

This indicator is constructed from the responses to the following set of prompted questions:

  • Do you strongly agree, agree, disagree or strongly disagree with the following statements?
  1. Most people living with HIV do not care if they infect other people.
  2. People get infected with HIV because they engage in irresponsible behaviors.
  3. People living with HIV should feel ashamed of themselves.
  4. Women living with HIV should be allowed to have babies if they wish.
Measurement frequency


Every 3-5 years

Strengths and weaknesses

Most people living with HIV do not care if they infect other people aims to capture health facility staff’s level of blame associated with "spreading" HIV in the community.

People get infected with HIV because they engage in irresponsible behaviors is related to the perception of an individual responsibility for their infection, as it captures the often common assumption that people are to blame for contracting HIV and/or contracted HIV because they have been irresponsible with their health. Identifying this perception among healthcare providers is important, as it could influence clinical decisions due to assumptions about the level of responsibility of a patient, and as a result, may lead the provider to be more or less coercive or not offer the preferred course of treatment because of judgments about a patient’s ability to adhere.

People living with HIV should feel ashamed of themselves taps into an emotional component of stigma.

Women living with HIV should not be allowed to have babies is aimed at assessing views of the reproductive rights of women living with HIV.

This indicator can be subject to social desirability bias which occurs when respondents provide what they perceive is the correct or acceptable response, as opposed to what they actually believe. In which case, this indicator would provide an under-reporting of stigma. Even with the potential for this type of response bias, the field-testing showed high levels of stigmatizing attitudes across these four statements and across countries. This suggests that the observed stigma levels would have been even higher in the absence of response bias. The use of self-administered (as opposed to interviewer administered) questionnaires may help reduce social desirability bias by providing a greater sense of anonymity. Furthermore, previous research has shown that respondents, who skip these types of questions for any number of reasons including comfort with the question, will answer at least one question if several questions measuring the same stigma domain are provided. Therefore, this indicator offers four questions so that if a respondent has a stigmatizing response to at least one of the items, then they are included in the numerator and denominator. By having a range of questions, missing data and social desirability can be reduced on this indicator.

Further information

For further information on the methodology and survey instruments, visit

Jain, A., and L. Nyblade. 2012. “Scaling Up Policies, Interventions, and Measurement for Stigma-Free HIV Prevention, Care, and Treatment Services.” Working Paper #3. Washington, DC: Futures Group, Health Policy Project.

Nyblade, L., Stangl, A., Weiss, E., & Ashburn, K. (2009). Combating HIV stigma in health care settings: what works?. Journal of the International AIDS Society,12(1), 15.

Nyblade, L. Jain, A. et al. Journal of the International AIDS Society 2013, 16(Suppl 2):18718 |