Health Facility Staff: Unnecessary Precautions and Measures (Tier 2)
It measures health facility staff’s use of unnecessary precautions or measures when providing care or services to a patient living with HIV. It measures personally enacted stigma.
The use of unwarranted or excessive precautions when providing care or services to a patient living with HIV in a healthcare setting stems from fear of HIV infection. The use of such differential and unnecessary precautions visibly marks and identifies HIV positive patients to other patients, as well as facility staff. This not only stigmatizes the HIV positive patients but can also make them targets of stigma from other patients or health facility staff.
Number of health facility staff who reported yes to either question
Number of all health facility staff who responded to at least one of the two statements
Numerator / Denominator
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 typically use any of the following measures when providing care or services for a patient living with HIV?
- Avoid physical contact
- Wear double gloves
Every 3-5 years
Avoiding physical contact or using double gloves with a patient living with HIV is an important manifestation of stigma to capture. It provides information about the unnecessary behaviors health facility staff uses to “protect” themselves, often without knowing that their actions are stigmatizing and can disclose a patient’s HIV status inadvertently to those around them.
This indicator may be subject to response bias as medical/clinical staff is likely to know what is considered appropriate and inappropriate behavior and be hesitant to report it happening.
Note there may still be some places where double gloves are considered standard or best practice. However, if this is the case then double gloves should be used universally for everyone, not just for patients living with HIV.
In addition to measuring fear of HIV infection in routine activities that health facility staff engages in with patients (Indicator 1.2), which is a driver of stigmatizing behavior in health facilities, it is also important to measure the actual behaviors that result from this fear -- the use of unnecessary measures and precautions. For example, additional analysis of the data collected in the field-tests were conducted to explore whether there was a relationship between staff worry about workplace HIV infection and use of unnecessary precautions. Findings showed that staff that worried about HIV infection were more likely to report the use of unnecessary precautions and measures with patients living with HIV.
For further information on the methodology and survey instruments, visit http://www.healthpolicyproject.com/index.cfm?ID=publications&get=pubID&p....
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. http://www.healthpolicyproject.com/index.cfm?id=publications&get=pubID&p...
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
http://www.jiasociety.org/index.php/jias/article/view/18718 | http://dx.doi.org/10.7448/IAS.16.3.18718