HIV-related stigma and discriminatory practices among healthcare providers in public hospitals in Yemen: A pre-conflict health services assessment

Background HIV-related stigma and discrimination in healthcare settings compromise equitable access to prevention, treatment, and care services. In fragile and conflict-affected settings such as Yemen, baseline evidence on healthcare provider stigma prior to health system disruption remains scarce. This study assessed HIV-related stigma and discriminatory practices among healthcare providers in public hospitals in Sana’a City before the onset of armed conflict. Methods A cross-sectional study was conducted in 2010 across four public hospitals in Sana’a City. HIV-related stigma was measured using 27 items covering four domains: blame of infection, fear of infection, desire for separation, and inequality of care. Discriminatory practices were assessed using nine items. Responses were recorded on a five-point Likert scale. Mean scores were expressed as percentages of maximum possible values and categorized as low (≤ 40%), moderate (41–60%), or high (≥ 61%). Multivariable linear regression was used to identify factors associated with stigma and discriminatory practices. Results Overall HIV-related stigma was moderate (55.9% of the maximum score), with highest levels observed in blame (63.9%) and fear of infection (64.9%) domains. Discriminatory practices were high (62.7% of the maximum score), with 65.5% of participants classified as exhibiting high discrimination. In multivariable analyses, higher stigma scores were independently associated with female gender (β = 4.0; 95% CI: 1.2–6.8), nursing occupation (β = 6.4; 95% CI: 1.6–11.2), and lack of prior experience in HIV care (β = 2.6; 95% CI: 0.1–5.1). Fear based stigma domain was the only independently factor associated with discriminatory practices (β = 0.36; 95% CI: 0.21–0.52; p < 0.001). Conclusions Moderate stigma and high levels of discriminatory practices were present among healthcare providers in public hospitals in Yemen prior to conflict-related health system disruption. Fear of occupational HIV exposure emerged as a key driver of discriminatory behavior, highlighting the importance of strengthening infection prevention training, enforcing non-discrimination policies, and integrating stigma-reduction strategies into health workforce development to support equitable HIV service delivery in fragile settings.