Drivers and Facilitators of HIV-Related Stigma in Healthcare Settings in Ireland

Abstract People living with HIV who experience stigma in healthcare settings are at increased risk for engaging in health avoidance behaviours, suboptimal adherence to antiretroviral therapy, and viral non-suppression. HIV-related stigma erodes trust between patients and healthcare providers, thereby undermining both individual and public health. This study aimed to identify predictors of stigmatising attitudes, stigma practices, and fear of occupational transmission among healthcare workers in the Republic of Ireland. Data were collected from 295 healthcare workers using a standardised tool designed to measure HIV-related stigma. The outcomes examined were stigmatising attitudes, stigmatising practices (such as excessive infection precaution measures), and fear of occupational transmission. Multiple linear regression analyses were conducted to explore predictors at the individual, clinic, and policy levels. The results indicated that none of the models significantly predicted stigmatising attitudes. However, stigmatising practices were positively associated with never having worked in an HIV clinic, lack of knowledge or agreement with the concept of ‘undetectable equals untransmittable’ (U = U), and the presence of institutional policies, collectively accounting for 25.3% of the variance. Fear of occupational transmission was positively predicted by gender and lack of knowledge or agreement with U = U, explaining 23.8% of the variance. The findings highlight the critical role of U = U knowledge in reducing stigma-related behaviours and fears among healthcare workers. Enhancing knowledge and acceptance of U = U as part of comprehensive stigma interventions may help reduce the stigma experienced by people living with HIV in healthcare settings.