1. Gender differences in HIV related stigma among doctors in Egypt Manal Benkirane, MD, MPH US Naval Medical Research Unit N. 3 Benkirane, M, Lohiniva AL, Abdelrahman E, Kamal W. and Talaat M

2. Background Stigma - barrier to care for PLHA. Little information on gender – stigma healthcare setting. Studies from Thailand and Belize: female healthcare workers are more stigmatizing than males. XIX International AIDS Conference 2012

3. Background MENA - Females in the general population more positive attitudes towards PLHA than males. No studies on gender differences and stigma in the healthcare setting in Egypt. XIX International AIDS Conference 2012

4. Study Objectives To explore gender differences in stigmatizing attitudes towards PLHA among doctors in Egypt. To provide gender based policy recommendations for stigma reduction. XIX International AIDS Conference 2012

5. Methods Cross sectional study design 2 tertiary care hospitals in Giza and Cairo governorates. XIX International AIDS Conference 2012

6. Methods N= 332 122 (37%) 210 (63 %) XIX International AIDS Conference 2012

7. Methods Data collection- October/December 2010 Structured questionnaire: – Socio-demographic information – HIV related misconceptions – Stigmatizing attitudes – Intention to treat PLHA. XIX International AIDS Conference 2012

8. Methods Misconceptions - percentages. Stigma - 3 scores developed. Answers coded 0 – 1. XIX International AIDS Conference 2012

9. Methods CategoryScaleCronbach Alpha Fear based stigma12 items.53 Value based stigma9 items.71 Intention to treat PLHA4 items.86 XIX International AIDS Conference 2012

10. Methods Stigma scores standardized to 10 for comparison purposes. Chi square and t- test. Linear regression – stigma scores. XIX International AIDS Conference 2012

11. Results XIX International AIDS Conference 2012

12. Results 1.Background characteristics of study participants 2.Misconceptions about HIV transmission 3.Stigmatizing attitudes towards PLHA 4.Intention to treat PLHA XIX International AIDS Conference 2012

13. Background characteristics No significant differences in terms of education, age, religion, working experience and training on HIV. – Most participants > 45 years – 25% doctors worked abroad – 12% received previous HIV training – 90% were Muslims Significant difference in origin – 60% females from capital city XIX International AIDS Conference 2012

14. Gender & HIV misconceptions XIX International AIDS Conference 2012

15. Gender & stigma scores XIX International AIDS Conference 2012

16. Gender & intention to treat PLHA XIX International AIDS Conference 2012

17. Gender & fear based stigma by age group XIX International AIDS Conference 2012

18. Gender & value based stigma by age group XIX International AIDS Conference 2012

19. Gender & intention to treat PLHA by age group XIX International AIDS Conference 2012

20. Linear regression Fear based stigma r 2 = 0.216 Value based stigma r 2 = 0.179 Intention to treat r 2 = 0.168 BP valueB B Constant -2.3420.000-1.9300.000-0.0760.873 Sex Male Female Ref -0.516 0.040 Ref - 0.988 0.015 Previous HIV training No Yes Ref 0.846 0.001 Ref 0.775 0.037 Fear based 0.360.008 Value based 0.2300.0000.4660.000 Origin Cairo Outside Cairo Ref -0.643 0.009 Post Graduate studies No Yes Ref -0.749 0.003 XIX International AIDS Conference 2012

21. Linear Regression Sex - significant predictor of value based stigma and intention to treat PLHA. Origin and education level were significant predictors of value based stigma. Previous HIV training and value based stigma was significant predictors for fear based stigma. Doctors with high value stigma score were more resistant to treat PLHA. XIX International AIDS Conference 2012

22. Conclusions XIX International AIDS Conference 2012

23. HIV related misconceptions > Social norms Culture Access to information XIX International AIDS Conference 2012

24. Fear based stigma > Social norms Limited access to information Fear of infection XIX International AIDS Conference 2012

25. Value based stigma > Conservativeness Moral judgments about the disease XIX International AIDS Conference 2012

26. Refusal to treat PLHA > Value driven multilayered? Resistance to deal with PLHA XIX International AIDS Conference 2012

27. Recommendations XIX International AIDS Conference 2012

28. Recommendations Need to prioritize and encourage women’s involvement in HIV training and education. Need to use a socio-cultural framework when addressing fear and value based stigma among female healthcare workers in Egypt. XIX International AIDS Conference 2012

29. Recommendations Emotional invoking strategies could be used in stigma reduction among females. Need to address stigma towards key populations at higher risk of infection. XIX International AIDS Conference 2012

30. Recommendations Need to explore other factors influencing female doctors’ willingness to treat PLHA. XIX International AIDS Conference 2012

31. Acknowledgements National AIDS Program, Egypt Global AIDS Program, Centers for Disease Control, Atlanta, US Om El Masryeen and Monira hospital management and teams. Ford Foundation XIX International AIDS Conference 2012

32. Questions?

33. Background characteristics Male Doctors N= 210 Female Doctors N = 122 P Value OriginCairo41.1%60.3%.001* Other58.9%39.7% Age group25-3445.7%39.7%.206 35-4411.0%14.0% 45 +43.3%46.3% ReligionMuslim93.8%91.0%.338 Christian6.2%9.0% Training outside Egypt13.3%9.0%.239 Working abroad25.2%23.0%.640 Previous HIV training11.4%11.5%.990 HospitalOm El masryeen59.5%58.2%.813 Monira40.5%41.8% XIX International AIDS Conference 2012