China Provider Project

China has one-fifth of the world’s population (1.4 billion people); the risk of an HIV pandemic is substantial. In 2005, AIDS surpassed hepatitis B to become the third deadliest infectious disease in China in 2005. The Chinese government has implemented a national program, “Four Frees and One Care,” which mandates access to free HIV testing and free anti-retroviral (ARV) treatment to AIDS patients in China.

As the demand for HIV treatment and care increases rapidly, service providers in China are at a critical point with growing responsibilities to deliver adequate services and care for patients living with HIV/AIDS (PLH). However, experiences of unwelcoming treatment often discourage PLH from seeking care from providers who exhibit discriminatory attitudes and behaviors. HIV-related stigma has a tremendous impact on PLH’s health outcomes, health seeking behavior, and treatment adherence. Only when patients’ fears of discrimination are reduced will they be more willing to participate in HIV testing and treatment.

The National Institute of Mental Health funds this four-year randomized controlled trial that addresses both individual and structural components to reduce HIV-related stigma among service providers in China. This intervention trial builds on a three-year pilot study that we conducted among 1,344 service providers in China from 2003 to 2006. From the pilot, we recognized the need to address HIV-related stigma by building social norms of acceptance and focusing on the well-being of all patients as well as service providers. This Popular Opinion Leader [POL] and access to universal precautions intervention integrates the behavioral level with the structural level and incorporates all core elements of the POL model with four training sessions and bi-monthly reunion sessions. We plan to train 600 POL providers in 40 county hospitals in Yunnan and Fujian, China.

The intervention trial will proceed in two phases. In Phase 1, we will develop and finalize the intervention, assessment instruments and implementation procedures. In Phase 2, we will randomly assign 40 hospitals to either: 1) an intervention group, or 2) a standard care group. The impact of the proposed intervention will be assessed over 12 months (baseline, 6 & 12 months), with 1,760 service providers and 1,000 patients. The provider outcomes are providers’ attitude and behavior changes toward patients and their universal precaution practice. The patient outcomes are patients’ perceived stigma, medical service utilization, and satisfaction and treatment adherence.

Published Journal Articles :

  1. Addressing HIV stigma in protected medical settings (2015) (3 downloads)
  2. Assessing outcomes of a stigma-reduction intervention with venue-based analysis (2014) (0 downloads)
  3. Using standardized patients to evaluate hospital-based intervention outcomes (2014) (0 downloads)
  4. Reducing HIV-Related Stigma in Health Care Settings: A Randomized Controlled Trial in China (2013) (0 downloads)
  5. Implementing a stigma reduction intervention in healthcare settings (2013) (0 downloads)
  6. A brief, standardized tool for measuring HIV-related stigma among health facility staff: results of field testing in China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis (2013) (1 download)
  7. Providers’ HIV-related Avoidance Attitude and Patient Satisfaction (2013) (0 downloads)
  8. Popular opinion leader intervention for HIV stigma reduction in health care settings (2013). (0 downloads)
  9. Empathy and avoidance in treating patients living with HIV/AIDS (PLWHA) among service providers in China (2012) (0 downloads)
  10. Regional differences in HIV prevalence and individual attitudes among service providers in China (2012) (0 downloads)
  11. HIV-Related Avoidance and Universal Precaution in Medical Settings: Opportunities to Intervene (2011) (0 downloads)
  12. Patient satisfaction in two Chinese provinces: rural and urban differences (2011) (0 downloads)