"Othering" the health worker: self-stigmatization of HIV/AIDS care among health workers in Swaziland

BACKGROUND HIV is an important factor affecting healthcare workforce capacity in high-prevalence countries, such as Swaziland. It contributes to loss of valuable healthcare providers directly through death and absenteeism and indirectly by affecting family members, increasing work volume and decreasing performance. This study explored perceived barriers to accessing HIV/AIDS care and prevention services among health workers in Swaziland. We asked health workers about their views on how HIV affects Swaziland's health workforce and what barriers and strategies health workers have for addressing HIV and using healthcare treatment facilities. METHODS Thirty-four semi-structured, in-depth interviews, including a limited set of quantitative questions, were conducted among health workers at health facilities representing the mixture of facility type, level and location found in the Swaziland health system. Data were collected by a team of Swazi nurses who had received training in research methods. Study sites were selected using a purposive sampling method while health workers were sampled conveniently with attention to representing a mixture of different cadres. Data were analyzed using Nvivo qualitative analysis software and Excel. RESULTS Health workers reported that HIV had a range of negative impacts on their colleagues and identified HIV testing and care as one of the most important services to offer health workers. They overwhelmingly wanted to know their own HIV status. However, they also indicated that in general, health workers were reluctant to access testing or care as they feared stigmatization by patients and colleagues and breaches of confidentiality. They described a self-stigmatization related to a professional need to maintain a HIV-free status, contrasting with the HIV-vulnerable general population. Breaching of this boundary included feelings of professional embarrassment and fear of colleagues' and patients' judgements. CONCLUSIONS While care is available and relatively accessible, Swaziland health workers still face unique usage barriers that relate to a self-stigmatizing process of boundary maintenance--described here as a form of "othering" from the HIV-vulnerable general population--and a lack of trust in privacy and confidentiality. Interventions that target health workers should address these issues.