Social Context, HIV Stigma, and Discrimination in Indonesian Healthcare Settings: a National Survey

Introduction: Despite a zero-stigma target, there has been limited national-level data on HIV stigma and discrimination among Indonesian healthcare workers. Past works were local and focused on individual-level stigma predictors. This study aims to fill in this gap by investigating national-level stigma and its social determinants. Methods A cross-sectional survey was conducted with stratified random sampling between October 2023-January 2024. Stigma was measured by agreement to four statements on attitudes toward PLHIV, while discrimination was measured by self-reported unnecessary extra precautions when caring for PLHIV. Social contexts included witnessing discriminatory care and perceived norms. Covariates included demographics, facility type, location, and work history. Logistic regression models were developed, adjusting for clustering by healthcare facilities. Results The study recruited 2,198 participants from 321 healthcare facilities, including 1,219 healthcare professionals and 979 support staff; 62.0% respondents expressed stigmatising attitudes; and 36.8% of healthcare professionals self-reported discriminatory practices. Participants in North Sumatra, relative to Jakarta, was the most salient for stigma (aOR = 6.15, 95%CI = 3.32–11.36) and East Java for discrimination (aOR = 5.45, 95%CI = 2.70–11.00). History of working in HIV services was a consistent negative predictor (aOR = 0.54, 95%CI = 0.43–0.68 for stigma; aOR = 0.74, 95%CI = 0.56–0.98 for discrimination). Conclusions We observed a considerable level of HIV stigma and discrimination. Structural factors that differ by province were the most salient determinants, along with gaps between perceived norms and best practices for anti-discriminatory HIV care. Future efforts to combat HIV stigma should focus on counteracting the structural factors while instilling the competence and norms for inclusive care for PLHIV and other HIV-affected groups.