Video intervention series reduces stigma towards people living with blood borne viruses, STIs
Centre for Social Research in Health
Centre for Social Research in Health
A study using short online videos of people living with blood borne viruses and sexually transmissible infections demonstrates a promising reduction of stigma in the short term.
A study using online videos to target discrimination against people living with blood borne viruses (BBVs) and sexually transmissible infections (STIs) has demonstrated an immediate reduction of stigmatising attitudes in the short term.
The study, conducted by the Centre for Social Research in Health (CSRH) at UNSW Sydney, surveyed adult Australians before and after viewing short videos of people talking about their experience of living with BBVs and STIs. Attitudes were again measured at a three-month follow-up.
The videos featured people from five priority groups: people who inject drugs, people living with HIV, people living with hepatitis C, people living with hepatitis B, and people employed in sex work.
While current Australian Government National Health Strategies for BBVs and STIs explicitly state the need to “eliminate the negative impact of stigma, discrimination, and legal and human rights issues on people’s health”, there has been a lack of evidence regarding effective interventions, one of the lead researchers, Associate Professor Loren Brener, says.
“Our study showed reductions in negative attitudes immediately after watching the videos for all groups, with significant positive changes in some attitudes maintained in the three-month follow-up,” A/Prof. Brener says. “This is a very encouraging.
“Stigmatising attitudes and behaviours by others can have negative and harmful effects for population groups and individual people affected by blood borne viruses, including on their quality of life, relationships and their willingness to access treatment.”
The contact intervention study was piloted with a sample of 2010 Australian adults recruited via Facebook advertising between February and May 2020.
The study examined overall attitudes towards the group, whether the stigmatised condition or behaviour was perceived to be within the person’s control (something they are perceived to have chosen), the desire to maintain personal distance from the group, and opinions regarding treatment of the group in healthcare and public policy settings.
Long-term reductions in negative attitudes were found in relation to the perceived controllability of HIV, hepatitis B perceived controllability and opinions, hepatitis C perceived controllability and opinions, and injecting drug use attitudes and opinions.
“Just being exposed to someone from that population group, talking about what it’s really like – humanising them – showed positive shifts in terms of people’s attitudes towards those groups,” says Dr Timothy Broady, a Senior Research Fellow at CSRH.
“In the three-month follow-up, the HIV intervention group demonstrated long-term improvements in relation to personal distance, and the hepatitis B intervention group demonstrated long-term improvements in relation to attitudes and personal distance, both as compared to the control group.”
Healthcare workers were also surveyed before and after watching a short online video of a respected clinician demonstrating a lack of stigma towards target groups in a related study.
“Stigma within health services is particularly associated with poorer health outcomes, as those affected often avoid accessing healthcare due to fears of negative treatment,” Dr Broady says.
The study was based on social norms theory: the belief that behaviour is heavily influenced by a misperception of conservatism in our peers, and that we can redress negative behaviours by challenging these misperceptions.
“Again, we saw some really encouraging short-term change… [with participants] less likely to agree with stigmatising behaviour towards those population groups [after watching the video],” Dr Broady says.
The team is considering options for expanding the studies’ reach as well as developing more tailored interventions for specific attributes and/or audiences, including one focused on structural stigma, or stigma that is institutionalised through discriminatory policy or practices.
“The studies demonstrate that these kinds of interventions offer an effective way to contribute to reducing stigma and discrimination towards people affected by BBVs,” Scientia Professor Carla Treloar, Director of CSRH, says.
“They have the potential to be scaled up and rolled out across jurisdictions at national and international levels.”
The intervention studies were developed in response to findings from the CSRH Stigma Indicators Monitoring Project, a sector-first longitudinal study funded by the Australian Government Department of Health.
The project monitors stigma among populations at risk of or living with blood borne viruses and sexually transmissible infections: men who have sex with men; people who inject drugs; people living with HIV; people living with viral hepatitis (B and C); and people employed in sex work. It also surveys healthcare workers and the general public’s attitudes to these groups.
The project is created in consultation with Hepatitis Australia, National Association of People Living with HIV Australia, Australian Federation of AIDS Organisations, Australasian Society for HIV Medicine, Australian Injecting and Illicit Drug Users' League and Scarlet Alliance.
Its necessity is evidenced in the prevalence of stigma captured in the report’s 2021 iteration: 86% of the general public sampled self-reported that they would behave negatively towards people who inject drugs to some extent, as did 56% of healthcare workers and 55% of healthcare students.
More than one-quarter of the general public (28%) indicated that they would ‘often’ or ‘always’ behave negatively to people who inject drugs. Additionally, 64% of the general public, and 36% and 31% of healthcare workers and students respectively, self-reported likely negative behaviour (to some extent) towards sex workers.
“Sex workers experience stigma on a daily basis in every facet of our lives. Sex workers know and experience this but generally there is a lack of awareness of how pervasive this is, including within the health sector,” says Jules Kim, CEO of Scarlet Alliance – Australian Sex Workers Association.
“We know that stigma and discrimination are primary drivers of BBV and STI, creating barriers to health and health care. The findings from this research have powerfully highlighted why we need regulatory and policy reform, including anti-discrimination and vilification protections for sex workers and the need for interventions to challenge and address stigma against sex workers and people who inject drugs.
“This research also provides a solid foundation for further development of measurable targets and indicators for actions to end stigma and discrimination within the National BBV and STI Strategies."
The report draws on data from several surveys developed by CSRH, as well as the Australian Survey of Social Attitudes (for the Australian public’s attitudes), and the HIV Futures 9 survey (for people living with HIV).
“These kinds of collaborations provide powerful evidence allowing us to advocate for change,” said Darryl O’Donnell, CEO of the Australian Federation of AIDS Organisations (AFAO).
“Our submission on the religious discrimination bill drew on data from the Stigma Indicators Monitoring Project to demonstrate how widespread stigma is for HIV-positive people and men who have sex with men. This was powerful and valuable.”
The project, now in its fifth year, has had input into national health strategies, such as the introduction of stigma as a separate pillar, with significant reduction targets (75%), in the NSW HIV Strategy 2021-2025.
These strategies represent a coordinated response to reduce the transmission, morbidity and mortality associated with these infections.
“Our data has demonstrated the extent to which stigma and discrimination are significant barriers to prevention, testing and treatment,” says A/Prof. Brener.
The ongoing monitoring of stigma will provide invaluable data to guide future interventions, Prof. Treloar says.
“The report documents the pervasiveness and nature of stigma for these vulnerable groups and enables us to track progress against the objectives as set out in the national strategies.
“However without concerted effort and strategic interventions, we cannot expect to see change,” she says.
Stigmatising attitudes and behaviours can have negative and harmful effects on people’s quality of life, relationships and willingness to access treatment, says Associate Professor Loren Brener.
This article was originally published in 2022.
Stigma can exist at all levels within a healthcare setting, from interactions between patient and clinician to policies and procedures in health practice. Understanding stigma and its impact on health systems and services is an important step to better meet the needs of people in marginalised groups and create a safe space for all.