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

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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. HIV stigma discrimination social practice Indonesia Introduction Aligned with its 95-95-95 HIV treatment targets for 2030, UNAIDS also developed a 10-10-10 societal enabler target. 1 , 2 It included reducing the proportion of people living with HIV (PLHIV) and associated key populations experiencing HIV stigma to fewer than 10%. 2 Aligned with this framework, the 2022 Indonesian regulatory framework and 2020–2024 national strategy for HIV response set up the Three Zero targets. 3 , 4 It aimed for zero instances of HIV-related stigma and discrimination, especially in healthcare settings. 3 , 4 This is an uphill battle, considering an analysis of the 2017 Indonesian Demographic and Health Survey found 85.9% of young Indonesians expressed some level of stigmatising attitude against PLHIV. 5 A 2025 scoping review further identified HIV stigma in Indonesia manifested in multiple forms, including avoidance of contact, negative reactions, to self-stigma. 6 In the healthcare setting, specifically, a 2024 community-led study found that 19.5% PLHIVs in Indonesia experienced some form of HIV stigma and discrimination in healthcare settings, including being advised not to have sex (11.2%), physical contact avoidance by healthcare workers (4.3%), and compromised confidentiality (4.1%) related to HIV status. 7 On the other hand, a 2022 study from Gunung Kidul, Indonesia, found that over 90% of healthcare workers engaged in discriminatory practices, in the form of unnecessary precautions and over 50% expressed intention to avoid duties involving caring for PLHIV patients. 8 Another 2025 study in Bandung, Indonesia, found that between 38% to 55% of nurses in Bandung, Indonesia, refused to care for PLHIV patients for various reasons. 9 Existing studies identified low HIV knowledge as the main contributing factor to HIV stigma in healthcare settings. 8 – 11 Despite the existing body of work, most of these were small in scope and local in nature. 8 – 11 Most also investigated potential contributing factors to stigma and discrimination at the individual level, such as knowledge or perceived HIV transmission risks. 8 – 11 While theoretically sound, it overlooked the importance of social context in the perpetuation of discriminatory practices. Viewed as a social practice, discrimination can be reproduced through the continuous reproduction of competences and meanings attached to discriminatory practices. 12 , 13 With this view, we can expect PLHIV stigma and discrimination can be associated with witnessing past discrimination or perceived norms, attaching meanings to discrimination. We can also expect varying levels of HIV stigma and discrimination in different localities, as each would have different penetration of competences and meanings attached to HIV discrimination. Therein lies the gap in the current body of works on HIV stigma and discrimination in Indonesia. The local scope prevented comparing social contexts across different. localities, combined with the fundamental lack of social phenomenology on HIV stigma and discrimination. Thus, this study aims to describe HIV stigma and discrimination in Indonesian healthcare settings and assess how elements of the social context, specifically witnessing discrimination and perceived consequences for discriminatory acts, contribute to their persistence. Methods Study Setting Twelve districts in six provinces were selected as sites for this study as recipients of technical assistance for district mentoring in HIV services provided by the Ministry of Health in collaboration with community organisations. These provinces were selected based on a combination of factors, including HIV case load, representation from the diverse Indonesian geographical and cultural landscape, and past local and regional studies on HIV stigma. Together, the districts represented over 188,000 key populations and serodiscordant partners of PLHIV and over 2,300 healthcare facilities. To the author’s knowledge, there was no ongoing monitoring of HIV stigma in the districts at the time of the survey. Concurrently with this project, a community-led stigma monitoring effort was also being devised. 7 Despite zero stigma and discrimination being a specific target enshrined in the Indonesian HIV strategy and national HIV response regulation, no monitoring or evaluation mechanism was outlined. 3 , 4 Study Design & Participants This study employed a cross-sectional design with stratified random sampling. Healthcare facilities were randomly selected for each district. A quota of 6 healthcare professionals and 4 support staff members was to be recruited from public health centres as well as public and private hospitals. The quota for support staff members was waived for private clinics or private practice, as they typically employ fewer staff members. At each healthcare facility, individual employees were randomly selected for interview until the quota for said facility was fulfilled or they ran out of employees to interview. Eligible participants were employees at healthcare facilities in the selected districts, including both healthcare professionals and supportive staff members, who have been employed at said facility for at least one month. Participation is entirely voluntary. Randomly selected employees could refuse to be interviewed, after which they were removed from the pool of potential participants. For each of the survey respondents and interview informants, informed consent was obtained. Participants’ autonomy, privacy, and confidentiality were consistently upheld throughout data collection and analysis. Data Collection & Variables Data collection was conducted through in-person structured interviews between October 2023 and January 2024 by trained enumerators guided by a survey instrument. The enumerator training was conducted online. Enumerators were recruited from local HIV-related CBOs from each surveyed district. Training focused on ethics, topic sensitivity, avoiding bias, project logistics, the digital survey tool, and the survey instrument. The instrument was developed based on the stigma and discrimination survey for a national estimation in Thailand. 14 HIV stigma, discrimination, and social context measures were measured through ordinal responses to statements on attitudes regarding PLHIV and practices in HIV care. Stigma statements, for example, included whether participants agree that PLHIV should be ashamed of their HIV status and whether female PLHIV should be sterilised against their will. Discrimination statements included experiences of double-gloving or other unnecessary extra precautions when caring for PLHIV patients. Social contexts included experiences of witnessing coworkers refusing to care for PLHIV or other HIV key populations and perceived norms regarding testing HIV without consent or professional repercussions for giving discriminatory care. Responses were dichotomised for analysis. Participants were considered to have a certain attitude if they responded ‘agree’ or ‘strongly agree’ to the relevant statements, whereas participants were considered to have practised or witnessed a practice if they responded anything other than ‘never’ for the relevant statements. Data on double-gloving or other unnecessary extra precautions were collected as a binary (yes/no) and retained as such for analysis. Other variables measured included demographics, workplace setting, and work history. Demographics included age, sex, education, and job titles. Work setting included the province and type of healthcare facilities. Work history included years of experience working in healthcare settings and experience working in HIV-related services. Analysis We developed multivariable logistic regression models to identify associations between social contexts with HIV stigma and discrimination, controlling for demographic, workplace setting, and work experience as covariates. Only independent variables and covariates with p < 0.25 in bivariate analyses were included in the multivariable models. Three models were developed for HIV stigma, with one model each for all participants, healthcare professionals, and support staff members. The model for HIV discrimination was a subgroup analysis for healthcare professionals, as the relevant questions were only asked to healthcare professionals. All models were adjusted for clustering based on healthcare facilities. All analyses were conducted on STATA 18 BE (StataCorp, College Station, TX). Results In total, 2,198 participants were recruited from 321 healthcare facilities. On average, there was a median of 5 (IQR 4-8) participants per healthcare facility. It included 1,219 (55.5%) healthcare professionals and 979 (44.5%) support staff members. Most participants were female or others (66.6%), were a Muslim (85.9%), had a college degree (73.8%), worked at public health centres (64.7%), and never worked in HIV care (65.1%). The characteristic differences between healthcare professionals and support staff members were statistically significant for all variables (Table 1). Table 1. Characteristics of participants. Variables Healthcare professionals (n=1,219) Support staff (n=979) Total (n=2,198) p Age, mean (SD) 38.0 (9.0) 35.7 (9.3) 37.0 (9.2) <0.001 Sex & gender, n (%) Male Female and others 253 (20.8) 966 (79.2) 481 (49.1) 498 (50.9) 734 (33.4) 1,464 (66.6) <0.001 Province, n (%) Jakarta West Java Central Java East Java North Sumatra South Sulawesi 195 (16.0) 164 (13.5) 215 (17.6) 272 (22.3) 225 (18.5) 148 (12.1) 204 (20.8) 159 (16.2) 181 (18.5) 172 (17.6) 131 (13.4) 132 (13.5) 399 (18.2) 323 (14.7) 396 (18.0) 444 (20.2) 356 (16.2) 280 (12.7) <0.001 Religion, n (%) Islam Other than Islam 1,009 (82.8) 210 (17.2) 879 (89.8) 100 (10.2) 1,888 (85.9) 310 (14.1) <0.001 Work experience, n (%) 10 years 385 (31.6) 314 (25.8) 520 (42.7) 424 (43.3) 299 (30.5) 256 (26.1) 809 (36.8) 613 (27.9) 776 (35.3) <0.001 Highest education, n (%) No college degree College degree 8 (0.7) 1,211 (99.3) 567 (57.9) 412 (42.1) 575 (26.2) 1,623 (73.8) <0.001 Healthcare facility type, n (%) PHCs Hospitals Others 817 (67.0) 387 (31.7) 15 (1.2) 606 (61.9) 353 (36.1) 20 (2.0) 1,423 (64.7) 740 (33.7) 35 (1.6) 0.024 Worked in HIV care, n (%) Never Past or current 610 (50.0) 609 (50.0) 820 (83.8) 159 (16.2) 1,430 (65.1) 768 (34.9) <0.001 The majority of participants (62.0%) agreed with at least one stigmatising attitude or belief, with the proportion of agreement higher among support staff members. Around a third (36.8%) of healthcare professionals also reported to typically practice at least one discriminatory practice when caring for PLHIV patients. On social context, a minority of participants (12.0%) reported having witnessed coworkers refusing or giving poor care to PLHIV or HIV key population patients, while most perceived a norm of not conducting HIV tests without consent (88.3%) or repercussions for discriminating against PLHIV (91.4%). Most of the social contexts did not significantly differ between healthcare professionals and support staff members (Table 2). Table 2. HIV stigma, discrimination, and the social context. Variables Healthcare professionals (n=1,219) Support staff (n=979) Total (n=2,198) p Stigma PLHIV don’t care that they infect people 447 (36.7) 332 (33.9) 779 (35.4) 0.179 PLHIV should be ashamed 140 (11.5) 193 (19.7) 333 (15.2) <0.001 PLHIV were irresponsible/immoral 475 (39.0) 447 (45.7) 922 (41.9) 0.002 Women with HIV should be sterilised 157 (12.8) 288 (29.4) 445 (20.2) <0.001 Any stigmatising beliefs/attitudes 722 (59.2) 641 (65.5) 1,363 (62.0) 0.003 Discriminatory practices Double-gloving. 342 (28.1) NA NA NA Unnecessary protective measures. 342 (28.1) NA NA NA Any discriminatory practices 448 (36.8) NA NA NA Social context: Witnessed coworker refused or give poor care to the following PLHIV 99 (8.1) 45 (4.6) 144 (6.6) <0.001 Gay or suspected to be gay 46 (3.8) 42 (4.3) 88 (4.0) 0.539 Transwoman or suspected to be 43 (3.5) 35 (3.6) 78 (3.5) 0.893 Sex workers or suspected of being 55 (4.5) 43 (4.4) 98 (4.5) 0.952 Drug users or suspected of being 41 (3.4) 36 (3.7) 77 (3.5) 0.691 Any PLHIV or HIV key populations 166 (13.6) 98 (10.0) 264 (12.0) 0.010 Social context: Perceived norms Unacceptable to test HIV without consent 1,084 (88.9) 856 (87.4) 1,940 (88.3) 0.281 Repercussions for discriminating PLHIV 1,104 (90.6) 904 (92.3) 2,008 (91.4) 0.142 No social context variables were consistently associated with stigmatising beliefs or attitudes across all multivariable models (Table 3). Agreeing that their workplace has a norm to not test for HIV without consent was positively associated with stigmatising attitude in the combined model (aOR 1.47, 95%CI 1.09-1.98). Covariates consistently associated with stigmatising attitudes or beliefs included province (positive association) and history of working in HIV care (negative association). Table 3. Multivariable model for social context and other factors associated with stigmatising attitudes and beliefs. Variables Healthcare professionals (n=1,219) aOR, 95%CI Support staff (n=979) aOR, 95%CI Total (n=2,198) aOR, 95%CI Social contexts Witnessed coworkers discriminating PLHIV/key population No Yes NA NA NA Unacceptable to test HIV without consent Disagree Agree Ref. 1.43 (0.97-2.11) NA Ref. 1.47 (1.09-1.98)* Repercussions for discriminating PLHIV Disagree Agree Ref. 1.01 (0.55-1.84) Ref. 0.52 (0.23-1.19) Ref. 0.79 (0.47-1.30) Covariates Age (each incremental year) 1.00 (0.98-1.02) 0.99 (0.97-1.00) NA Sex & gender Male Female and others NA NA NA Province Jakarta West Java Central Java East Java North Sumatra South Sulawesi Ref. 3.46 (2.00-5.99)** 2.89 (1.76-4.75)** 2.81 (1.72-4.59)** 7.45 (3.64-15.23)** 1.84 (0.96-3.52) Ref. 4.03 (2.38-6.83)** 3.48 (1.97-6.14)** 2.95 (1.68-5.19)** 5.15 (2.77-9.56)** 1.54 (0.78-3.06) Ref. 3.85 (2.45-6.05)** 3.28 (2.16-4.98)** 2.92 (1.87-4.54)** 6.15 (3.32-11.36)** 1.81 (1.00-3.27)* Religion Islam Other than Islam Ref. 0.81 (0.53-1.23) NA NA Work experience 10 years Ref. 0.98 (0.70-1.38) 1.17 (0.80-1.73) NA Ref. 1.01 (0.80-1.29) 1.10 (0.88-1.39) Highest education No college degree College degree NA Ref. 1.06 (0.77-1.47) NA Healthcare facility type PHCs Hospitals Others Ref. 1.26 (0.87-1.38) 0.45 (0.13-1.57) Ref. 1.19 (0.80-1.78) 0.28 (0.12-0.64)** Ref. 1.24 (0.90-1.70) 0.33 (0.16-0.68)** Worked in HIV care Never Past or current Ref. 0.57 (0.45-0.73)** Ref. 0.49 (0.31-0.78)** Ref. 0.54 (0.43-0.68)** Job description Healthcare professional Support staff - - Ref. 1.22 (1.01-1.47)* NA: p>0.25 in bivariate analysis; *p<0.05; **p<0.01 Agreeing to ‘unacceptable to test for HIV without consent’ was negatively associated with discriminating practices (aOR 0.58, 95%CI 0.35-0.96), while believing there were repercussions for discriminating against HIV was positively associated (aOR 2.40, 95%CI 1.04-5.54). Having any stigmatising attitude was also a positive predictor (aOR 1.67, 95%CI 1.27-2.22). Other covariates significantly associated with discriminatory practices included province (positive association) and experience working in HIV care as (negative association). Table 4. Multivariable model for social contexts and other factors associated with discriminatory practices. Variables Healthcare professionals (n=1,219) aOR, 95%CI Social contexts Witnessed coworkers discriminating PLHIV/key population No Yes Ref. 1.41 (0.93-2.13) Unacceptable to test HIV without consent Disagree Agree Ref. 0.58 (0.35-0.96)* Repercussions for discriminating PLHIV Disagree Agree Ref. 2.40 (1.04-5.54)* Covariates Any stigmatising beliefs or attitude No Yes Ref. 1.67 (1.27-2.22)* Age (each incremental year) 0.98 (0.96-1.00)* Sex & gender Male Female and others NA Province Jakarta West Java Central Java East Java North Sumatra South Sulawesi Ref. 2.45 (1.14-5.25)** 4.49 (2.22-9.08)** 5.45 (2.70-11.00)** 1.37 (0.54-3.48) 2.77 (1.32-5.84)** Religion Islam Other than Islam Ref. 0.73 (0.46-1.16) Work experience 10 years Ref. 1.04 (0.74-1.45) 1.12 (0.74-1.72) Highest education No college degree College degree NA Healthcare facility type PHCs Hospitals Others NA Worked in HIV care Never Past or current Ref. 0.74 (0.56-0.98)* NA: p>0.25 in bivariate analysis; *p<0.05; **p<0.01 Discussions To our knowledge, this study is one of the first to explore HIV stigma and discrimination in the Indonesian healthcare setting at a national scale, simultaneously involving multiple districts and provinces. We observe a considerable level of HIV stigma and discrimination among healthcare workers, with 62.0% of participants agreeing with at least one stigmatising attitude, including 20.2% agreeing that PLHIV women should be sterilised. Among healthcare professionals, 36.8% reported having engaged in HIV discrimination in the form of unnecessary precaution. Localities outside of Jakarta (used as the reference group) was found to be the most salient factor positively associated with stigma and discrimination. Other social contexts, such as witnessing HIV discrimination by coworkers or perceived norms, were also found as predictors, although the direction and effect size were inconsistent across models. This finding highlights the gap between Indonesia's aim for zero HIV discrimination and the reality in the field. While the 36.8% proportion of self-reported discriminatory practice that we observed is lower than past local studies in Gunung Kidul in 2022 (over 90%) or in Bandung in 2025 (between 38–55%), 8, 9 it is unknown if it represents a real progress in stigma reduction or inter-localities variance. The latter is especially likely considering the salience of localities as a predictor in our study. This is evident by the salience of geographical disparity for stigma and discrimination. Participants in North Sumatra were found to be significantly more likely to express stigmatising attitude than those in Jakarta. Similarly, participants in East Java were more likely to self-report discriminatory practices. Analyses of a 2017 nationwide community-based survey found that people in Sumatra reported higher HIV stigma compared to Java, a similar pattern to our observation, corroborating the suggestion that structural factors affect the localities of competence and meaning of HIV stigma among healthcare workers. 5 , 15 While not direct evidence, it suggests a salience of structural factors within localities as an element of habitus that were not captured by our social context variables: witnessing discrimination or perceived norms included in our model. Previous studies provide hints of these structural factors. One potential structural factor was regional variation of social and religious norms as reported by a 2021 qualitative study which linked HIV stigma with perceived opposition to social and religious norms. 11 , 16 Another potential structural factor was training curricula as a 2022 study among healthcare trainees reported differences in stigmatising attitudes not only based on geography, but also between different schools and professional training. 17 While structural in nature, these factors shaped the localities where practices were situated and habitues were formed, which consequently shaped how stigma and discrimination were reproduced in each geographical setting. Our findings also reveal a paradox. Perceiving a norm of repercussions against discrimination was associated with a greater likelihood of engaging in unnecessary precautions, while perceiving a norm against testing without consent predicted less discrimination. This is similar to a 2022 local Indonesian study showing a history of HIV training as a positive predictor of intention to avoid providing care for PLHIV. 8 This suggests a misalignment between the embodied norms within the habitus and localities of participants and the formal standards that define discrimination. Unnecessary extra precaution, which was how we defined discrimination in this study, may register as professional diligence rather than discrimination among participants due to misconceptions about HIV transmission risks. 8 , 11 Another interesting finding is that a history of working in HIV services was consistently shown as a negative predictor for HIV stigma and discrimination. This has also been consistently shown in previous Indonesian studies. 8 , 9 Similar findings have also been observed in China, Taiwan, and Nigeria. 18 – 20 Specialised HIV units may have higher awareness of stigma and discrimination. As localities, they may have had their own norms which discourages HIV stigma and discrimination. Our findings and past studies show that healthcare workers exposed to experiences in these HIV unit localities may carry it to their new workplaces. 18 – 20 Changing the habitus of HIV stigma and discrimination as a social practice requires changes to the competences and meanings associated with these practices in the localities where it was practised. 12 , 13 Measures should be taken to counteract the embedded stigma against HIV and key populations in the wider society so that the healthcare system can be a safe space for PLHIV and other HIV-affected communities. It aligns with global strategies calling for public health reforms and accountability against stigma and discrimination. 1 , 2 , 21 Hand in hand, competence on HIV knowledge and patient rights should also be built to align anti-discrimination norms with best practices regarding non-discriminatory HIV care. 8 , 9 Evidence from our findings and past studies showed that exposure to HIV services was able to impart both HIV knowledge and build empathy toward HIV-affected communities. 11 , 18 – 20 This could be scaled up in the form of experiential training operationalised through clinical rotations, integrated into formal curricula for healthcare professionals’ formal training, or continuing professional education. 11 , 17 , 22 The strengths of our study were its national scope, one of the first for Indonesia, and our focus on social and policy frameworks. On the other hand, our findings should be seen with acknowledgment of their limitations. Increasing awareness of HIV stigma may have led to some social desirability bias. Although comparable to some past studies, 8, 18, 19 our measure of HIV stigma and discrimination was very specific and may not have accounted for other forms of discrimination described in prior Indonesian qualitative studies. 10 , 11 Similar national-level studies with a more robust measurement framework should be routinely conducted in Indonesia to monitor the trend of HIV stigma and discrimination. Conclusions This national-scale study highlights that HIV stigma and discrimination remain prevalent among healthcare workers in Indonesia, with significant variation across provinces, suggesting the salience of both structural and social factors. Key predictors identified include provincial differences, social contexts, and professional experience within HIV services, the latter consistently reducing stigmatising attitudes. Our findings reinforce the need for targeted interventions addressing both the social and structural drivers of stigma, including broader societal norms and localised habitus. Efforts should prioritise integrating anti-discrimination principles and comprehensive HIV education into healthcare training and ongoing professional development. Continued national-level monitoring using robust measurement frameworks is essential to track progress and inform policy, aligning with global strategies to end HIV-related inequalities and discrimination. Declarations The protocol of this study was reviewed, and ethical clearance has been obtained from Research Ethics Committee of the Faculty of Medicine, Udayana University with document number 2451/UN14.2.2.VII.14/LT/2023 Author Contribution PPJ, BDKW, NPAH, KD, NKS, and BO were responsible for the study conception and design. Data collection was organised by BDKW, NPAH, NKS, KD, and BO. Data analysis and the first draft of the manuscript were prepared by GBSW. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgement Parts of this work were supported by UNAIDS as part of their work supporting the Indonesian national HIV program. Data Availability Deidentified data and codes are available upon reasonable request to the authors. References UNAIDS. (2021). Global AIDS Strategy 2021–2026: End Inequalities, End AIDS . Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS. (2021). Ending Inequalities and Getting on Track to End AIDS by 2030 . Joint United Nations Programme on HIV/AIDS. Indonesian Ministry of Health. (2023). Minister of Health Regulation Number 23 of 2022 on the Management of Human Immunodeficiency Virus, Acquired Immuno-Deficiency Syndrome, and Sexually Transmitted Infection . Ministry of Health. Indonesian Ministry of Health (2020). Strategic Action Plan for Prevention of HIV and STIs in Indonesia 2020–2024. https://hivaids-pimsindonesia.or.id/download/file/RAN_AIDS_2024.pdf accessed 31 March 2025). Wirawan, G. B. S., Gustina, N. L. Z., & Januraga, P. P. (2022). Open Communication About Reproductive Health Is Associated With Comprehensive HIV Knowledge and a Non-stigmatising Attitude Among Indonesian Youth: A Cross-sectional Study. J Prev Med Public Health , 55 , 342–350. 2022/08/09 Sudastri, N. K., Wulandari, L. P. L., & Januraga, P. P. (2025). Manifestation and Markings of HIV Stigma in Indonesia: A Scoping Review. Int J Environ Res Public Health ; 22 2025/06/26. 10.3390/ijerph22060840 Jaringan Indonesia Positif. (2024). People Living with HIV Stigma Index 2.0 in Indonesia . Jaringan Indonesia Positif. Langi, G. G., Rahadi, A., Praptoraharjo, I., et al. (2022). HIV-related stigma and discrimination among health care workers during early program decentralization in rural district Gunungkidul, Indonesia: a cross-sectional study. Bmc Health Services Research , 22 , 356. 2022/03/19 Wilandika, A., Sajodin, Rohmah, S. F., et al. (2025). Stigma Toward Patients Living With HIV Among Nurses Within Public Hospital in Bandung, Indonesia. Asian Nurs Res (Korean Soc Nurs Sci) , 19 , 284–290. 2025/05/23 Fauk, N. K., Hawke, K., Mwanri, L., et al. (2021). Stigma and Discrimination towards People Living with HIV in the Context of Families, Communities, and Healthcare Settings: A Qualitative Study in Indonesia. International Journal Of Environmental Research And Public Health , 18 . 10.3390/ijerph18105424 . 2021/06/03. Fauk, N. K., Ward, P. R., Hawke, K., et al. (2021). HIV Stigma and Discrimination: Perspectives and Personal Experiences of Healthcare Providers in Yogyakarta and Belu, Indonesia. Front Med (Lausanne) , 8 , 625787. 2021/06/01 Blue, S., Shove, E., Carmona, C., et al. (2014). Theories of practice and public health: understanding (un)healthy practices. Critical Public Health , 26 , 36–50. 10.1080/09581596.2014.980396 Guise, A. (2024). Stigma power in practice: Exploring the contribution of Bourdieu's theory to stigma, discrimination and health research. Social Science And Medicine , 347 , 116774. 10.1016/j.socscimed.2024.116774 . 2024/03/28. Siraprasiri, T., Srithanaviboonchai, K., Chariyalertsak, S., et al. (2016). Stigma and Discrimination Among Health Care Providers, People Living with HIV and Key Populations in Thailand: Extrapolation Process for National Estimates . Department of Disease Control, Ministry of Public Health. Arifin, H., Ibrahim, K., Rahayuwati, L., et al. (2022). HIV-related knowledge, information, and their contribution to stigmatization attitudes among females aged 15–24 years: regional disparities in Indonesia. Bmc Public Health , 22 , 637. 2022/04/03 Fauk, N. K., Ward, P. R., Hawke, K. (2021). Cultural and religious determinants of HIV transmission: A qualitative study with people living with HIV in Belu and Yogyakarta, Indonesia. PLoS One ; 16: e0257906. 2021 /11/16 . DOI: 10.1371/journal.pone.0257906. Waluyo, A., Mansyur, M., Earnshaw, V. A., et al. (2022). Exploring HIV stigma among future healthcare providers in Indonesia. Aids Care , 34 , 29–38. 10.1080/09540121.2021.1897777 . 2021/03/16. Toh, H. S., Ku, H. C., Chen, W. P. (2025). Towards zero discrimination: a survey on HIV-related stigma and discrimination among healthcare providers in a medical center in Southern Taiwan. Sex Health ; 22 2025/09/22. 10.1071/SH24172 Jia, S., Yue, C., Zhang, L., et al. (2025). HIV/AIDS-related stigma and discrimination among healthcare providers in Western China: a population-based cross-sectional study. Bmc Infectious Diseases , 25 , 951. 2025/07/29 Galal, Y. S., Khairy, W. A., Mohamed, R., et al. (2022). HIV-related stigma and discrimination by healthcare workers in Egypt. Transactions Of The Royal Society Of Tropical Medicine And Hygiene , 116 , 636–644. 2022/01/10 UNAIDS. (2025). Draft recommendations - Global Task Team for Setting 2030 HIV Targets . Joint United Nations Programme on HIV/AIDS. Mak, W. W., Cheng, S. S., Law, R. W., et al. (2015). Reducing HIV-related stigma among health-care professionals: a game-based experiential approach. Aids Care , 27 , 855–859. 2015/02/12 Additional Declarations No competing interests reported. Supplementary Files SRSPSocialContextofStigmaTableS1V120251113.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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12:25:39","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":17608,"visible":true,"origin":"","legend":"","description":"","filename":"SRSPSocialContextofStigmaTableS1V120251113.docx","url":"https://assets-eu.researchsquare.com/files/rs-8380565/v1/8e3e30e74595eaf18c6e4661.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Social Context, HIV Stigma, and Discrimination in Indonesian Healthcare Settings: a National Survey","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAligned with its 95-95-95 HIV treatment targets for 2030, UNAIDS also developed a 10-10-10 societal enabler target.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e It included reducing the proportion of people living with HIV (PLHIV) and associated key populations experiencing HIV stigma to fewer than 10%.\u003csup\u003e2\u003c/sup\u003e Aligned with this framework, the 2022 Indonesian regulatory framework and 2020\u0026ndash;2024 national strategy for HIV response set up the Three Zero targets.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e It aimed for zero instances of HIV-related stigma and discrimination, especially in healthcare settings.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis is an uphill battle, considering an analysis of the 2017 Indonesian Demographic and Health Survey found 85.9% of young Indonesians expressed some level of stigmatising attitude against PLHIV.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e A 2025 scoping review further identified HIV stigma in Indonesia manifested in multiple forms, including avoidance of contact, negative reactions, to self-stigma.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the healthcare setting, specifically, a 2024 community-led study found that 19.5% PLHIVs in Indonesia experienced some form of HIV stigma and discrimination in healthcare settings, including being advised not to have sex (11.2%), physical contact avoidance by healthcare workers (4.3%), and compromised confidentiality (4.1%) related to HIV status.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e On the other hand, a 2022 study from Gunung Kidul, Indonesia, found that over 90% of healthcare workers engaged in discriminatory practices, in the form of unnecessary precautions and over 50% expressed intention to avoid duties involving caring for PLHIV patients.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Another 2025 study in Bandung, Indonesia, found that between 38% to 55% of nurses in Bandung, Indonesia, refused to care for PLHIV patients for various reasons.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Existing studies identified low HIV knowledge as the main contributing factor to HIV stigma in healthcare settings.\u003csup\u003e\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite the existing body of work, most of these were small in scope and local in nature.\u003csup\u003e\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Most also investigated potential contributing factors to stigma and discrimination at the individual level, such as knowledge or perceived HIV transmission risks.\u003csup\u003e\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhile theoretically sound, it overlooked the importance of social context in the perpetuation of discriminatory practices. Viewed as a social practice, discrimination can be reproduced through the continuous reproduction of competences and meanings attached to discriminatory practices.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e With this view, we can expect PLHIV stigma and discrimination can be associated with witnessing past discrimination or perceived norms, attaching meanings to discrimination. We can also expect varying levels of HIV stigma and discrimination in different localities, as each would have different penetration of competences and meanings attached to HIV discrimination.\u003c/p\u003e \u003cp\u003eTherein lies the gap in the current body of works on HIV stigma and discrimination in Indonesia. The local scope prevented comparing social contexts across different. localities, combined with the fundamental lack of social phenomenology on HIV stigma and discrimination. Thus, this study aims to describe HIV stigma and discrimination in Indonesian healthcare settings and assess how elements of the social context, specifically witnessing discrimination and perceived consequences for discriminatory acts, contribute to their persistence.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003eStudy Setting\u003c/p\u003e \u003cp\u003e Twelve districts in six provinces were selected as sites for this study as recipients of technical assistance for district mentoring in HIV services provided by the Ministry of Health in collaboration with community organisations. These provinces were selected based on a combination of factors, including HIV case load, representation from the diverse Indonesian geographical and cultural landscape, and past local and regional studies on HIV stigma. Together, the districts represented over 188,000 key populations and serodiscordant partners of PLHIV and over 2,300 healthcare facilities. To the author\u0026rsquo;s knowledge, there was no ongoing monitoring of HIV stigma in the districts at the time of the survey. Concurrently with this project, a community-led stigma monitoring effort was also being devised.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Despite zero stigma and discrimination being a specific target enshrined in the Indonesian HIV strategy and national HIV response regulation, no monitoring or evaluation mechanism was outlined.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStudy Design \u0026amp; Participants\u003c/p\u003e \u003cp\u003eThis study employed a cross-sectional design with stratified random sampling. Healthcare facilities were randomly selected for each district. A quota of 6 healthcare professionals and 4 support staff members was to be recruited from public health centres as well as public and private hospitals. The quota for support staff members was waived for private clinics or private practice, as they typically employ fewer staff members. At each healthcare facility, individual employees were randomly selected for interview until the quota for said facility was fulfilled or they ran out of employees to interview.\u003c/p\u003e \u003cp\u003eEligible participants were employees at healthcare facilities in the selected districts, including both healthcare professionals and supportive staff members, who have been employed at said facility for at least one month. Participation is entirely voluntary. Randomly selected employees could refuse to be interviewed, after which they were removed from the pool of potential participants. For each of the survey respondents and interview informants, informed consent was obtained. Participants\u0026rsquo; autonomy, privacy, and confidentiality were consistently upheld throughout data collection and analysis.\u003c/p\u003e \u003cp\u003eData Collection \u0026amp; Variables\u003c/p\u003e \u003cp\u003eData collection was conducted through in-person structured interviews between October 2023 and January 2024 by trained enumerators guided by a survey instrument. The enumerator training was conducted online. Enumerators were recruited from local HIV-related CBOs from each surveyed district. Training focused on ethics, topic sensitivity, avoiding bias, project logistics, the digital survey tool, and the survey instrument.\u003c/p\u003e \u003cp\u003eThe instrument was developed based on the stigma and discrimination survey for a national estimation in Thailand.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e HIV stigma, discrimination, and social context measures were measured through ordinal responses to statements on attitudes regarding PLHIV and practices in HIV care.\u003c/p\u003e \u003cp\u003e Stigma statements, for example, included whether participants agree that PLHIV should be ashamed of their HIV status and whether female PLHIV should be sterilised against their will. Discrimination statements included experiences of double-gloving or other unnecessary extra precautions when caring for PLHIV patients. Social contexts included experiences of witnessing coworkers refusing to care for PLHIV or other HIV key populations and perceived norms regarding testing HIV without consent or professional repercussions for giving discriminatory care.\u003c/p\u003e \u003cp\u003eResponses were dichotomised for analysis. Participants were considered to have a certain attitude if they responded \u0026lsquo;agree\u0026rsquo; or \u0026lsquo;strongly agree\u0026rsquo; to the relevant statements, whereas participants were considered to have practised or witnessed a practice if they responded anything other than \u0026lsquo;never\u0026rsquo; for the relevant statements. Data on double-gloving or other unnecessary extra precautions were collected as a binary (yes/no) and retained as such for analysis.\u003c/p\u003e \u003cp\u003eOther variables measured included demographics, workplace setting, and work history. Demographics included age, sex, education, and job titles. Work setting included the province and type of healthcare facilities. Work history included years of experience working in healthcare settings and experience working in HIV-related services.\u003c/p\u003e \u003cp\u003eAnalysis\u003c/p\u003e \u003cp\u003eWe developed multivariable logistic regression models to identify associations between social contexts with HIV stigma and discrimination, controlling for demographic, workplace setting, and work experience as covariates. Only independent variables and covariates with p\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in bivariate analyses were included in the multivariable models. Three models were developed for HIV stigma, with one model each for all participants, healthcare professionals, and support staff members. The model for HIV discrimination was a subgroup analysis for healthcare professionals, as the relevant questions were only asked to healthcare professionals. All models were adjusted for clustering based on healthcare facilities. All analyses were conducted on STATA 18 BE (StataCorp, College Station, TX).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn total, 2,198 participants were recruited from 321 healthcare facilities. On average, there was a median of 5 (IQR 4-8) participants per healthcare facility. It included 1,219 (55.5%) healthcare professionals and 979 (44.5%) support staff members. \u0026nbsp;Most participants were female or others (66.6%), were a Muslim (85.9%), had a college degree (73.8%), worked at public health centres (64.7%), and never worked in HIV care (65.1%). The characteristic differences between healthcare professionals and support staff members were statistically significant for all variables (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1. Characteristics of participants.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare professionals (n=1,219)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupport staff (n=979)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=2,198)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAge, mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e38.0 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e35.7 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e37.0 (9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSex \u0026amp; gender, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Female and others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e253 (20.8)\u003c/p\u003e\n \u003cp\u003e966 (79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e481 (49.1)\u003c/p\u003e\n \u003cp\u003e498 (50.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e734 (33.4)\u003c/p\u003e\n \u003cp\u003e1,464 (66.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eProvince, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Jakarta\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;West Java\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Central Java\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;East Java\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;North Sumatra\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;South Sulawesi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e195 (16.0)\u003c/p\u003e\n \u003cp\u003e164 (13.5)\u003c/p\u003e\n \u003cp\u003e215 (17.6)\u003c/p\u003e\n \u003cp\u003e272 (22.3)\u003c/p\u003e\n \u003cp\u003e225 (18.5)\u003c/p\u003e\n \u003cp\u003e148 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e204 (20.8)\u003c/p\u003e\n \u003cp\u003e159 (16.2)\u003c/p\u003e\n \u003cp\u003e181 (18.5)\u003c/p\u003e\n \u003cp\u003e172 (17.6)\u003c/p\u003e\n \u003cp\u003e131 (13.4)\u003c/p\u003e\n \u003cp\u003e132 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e399 (18.2)\u003c/p\u003e\n \u003cp\u003e323 (14.7)\u003c/p\u003e\n \u003cp\u003e396 (18.0)\u003c/p\u003e\n \u003cp\u003e444 (20.2)\u003c/p\u003e\n \u003cp\u003e356 (16.2)\u003c/p\u003e\n \u003cp\u003e280 (12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eReligion, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Islam\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Other than Islam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,009 (82.8)\u003c/p\u003e\n \u003cp\u003e210 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e879 (89.8)\u003c/p\u003e\n \u003cp\u003e100 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,888 (85.9)\u003c/p\u003e\n \u003cp\u003e310 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWork experience, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026lt; 5 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5-10 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026gt; 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e385 (31.6)\u003c/p\u003e\n \u003cp\u003e314 (25.8)\u003c/p\u003e\n \u003cp\u003e520 (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e424 (43.3)\u003c/p\u003e\n \u003cp\u003e299 (30.5)\u003c/p\u003e\n \u003cp\u003e256 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e809 (36.8)\u003c/p\u003e\n \u003cp\u003e613 (27.9)\u003c/p\u003e\n \u003cp\u003e776 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eHighest education, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No college degree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;College degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (0.7)\u003c/p\u003e\n \u003cp\u003e1,211 (99.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e567 (57.9)\u003c/p\u003e\n \u003cp\u003e412 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e575 (26.2)\u003c/p\u003e\n \u003cp\u003e1,623 (73.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eHealthcare facility type, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;PHCs\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hospitals\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e817 (67.0)\u003c/p\u003e\n \u003cp\u003e387 (31.7)\u003c/p\u003e\n \u003cp\u003e15 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e606 (61.9)\u003c/p\u003e\n \u003cp\u003e353 (36.1)\u003c/p\u003e\n \u003cp\u003e20 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,423 (64.7)\u003c/p\u003e\n \u003cp\u003e740 (33.7)\u003c/p\u003e\n \u003cp\u003e35 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWorked in HIV care, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Never\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Past or current\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e610 (50.0)\u003c/p\u003e\n \u003cp\u003e609 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e820 (83.8)\u003c/p\u003e\n \u003cp\u003e159 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,430 (65.1)\u003c/p\u003e\n \u003cp\u003e768 (34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe majority of participants (62.0%) agreed with at least one stigmatising attitude or belief, with the proportion of agreement higher among support staff members. Around a third (36.8%) of healthcare professionals also reported to typically practice at least one discriminatory practice when caring for PLHIV patients. On social context, a minority of participants (12.0%) reported having witnessed coworkers refusing or giving poor care to PLHIV or HIV key population patients, while most perceived a norm of not conducting HIV tests without consent (88.3%) or repercussions for discriminating against PLHIV (91.4%). Most of the social contexts did not significantly differ between healthcare professionals and support staff members (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. HIV stigma, discrimination, and the social context.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"602\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare professionals\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=1,219)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupport staff\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=979)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=2,198)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStigma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003ePLHIV don\u0026rsquo;t care that they infect people\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e447 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e332 (33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e779 (35.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003ePLHIV should be ashamed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e140 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e193 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e333 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003ePLHIV were irresponsible/immoral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e475 (39.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e447 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e922 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003eWomen with HIV should be sterilised\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e157 (12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e288 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e445 (20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny stigmatising beliefs/attitudes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e722 (59.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e641 (65.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1,363 (62.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiscriminatory practices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003eDouble-gloving.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e342 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003eUnnecessary protective measures.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e342 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny discriminatory practices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e448 (36.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 539px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial context: Witnessed coworker refused or give poor care to the following\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003ePLHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e99 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e45 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e144 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003eGay or suspected to be gay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e46 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e42 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e88 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.539\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003eTranswoman or suspected to be\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e43 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e35 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e78 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003eSex workers or suspected of being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e55 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e43 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e98 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003eDrug users or suspected of being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e41 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e36 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e77 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.691\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny PLHIV or HIV key populations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e166 (13.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e98 (10.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e264 (12.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial context: Perceived norms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003eUnacceptable to test HIV without consent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1,084 (88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e856 (87.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1,940 (88.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 267px;\"\u003e\n \u003cp\u003eRepercussions for discriminating PLHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e1,104 (90.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e904 (92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e2,008 (91.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNo social context variables were consistently associated with stigmatising beliefs or attitudes across all multivariable models (Table 3). Agreeing that their workplace has a norm to not test for HIV without consent was positively associated with stigmatising attitude in the combined model (aOR 1.47, 95%CI 1.09-1.98). Covariates consistently associated with stigmatising attitudes or beliefs included province (positive association) and history of working in HIV care (negative association).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Multivariable model for social context and other factors associated with stigmatising attitudes and beliefs.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare professionals (n=1,219)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eaOR, 95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupport staff (n=979)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eaOR, 95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=2,198)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eaOR, 95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial contexts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eWitnessed coworkers discriminating PLHIV/key population\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eUnacceptable to test HIV without consent\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Disagree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.43 (0.97-2.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.47 (1.09-1.98)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eRepercussions for discriminating PLHIV\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Disagree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.01 (0.55-1.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e0.52 (0.23-1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e0.79 (0.47-1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCovariates\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eAge (each incremental year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.00 (0.98-1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.99 (0.97-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eSex \u0026amp; gender\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Female and others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eProvince\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Jakarta\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;West Java\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Central Java\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;East Java\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;North Sumatra\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;South Sulawesi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e3.46 (2.00-5.99)**\u003c/p\u003e\n \u003cp\u003e2.89 (1.76-4.75)**\u003c/p\u003e\n \u003cp\u003e2.81 (1.72-4.59)**\u003c/p\u003e\n \u003cp\u003e7.45 (3.64-15.23)**\u003c/p\u003e\n \u003cp\u003e1.84 (0.96-3.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e4.03 (2.38-6.83)**\u003c/p\u003e\n \u003cp\u003e3.48 (1.97-6.14)**\u003c/p\u003e\n \u003cp\u003e2.95 (1.68-5.19)**\u003c/p\u003e\n \u003cp\u003e5.15 (2.77-9.56)**\u003c/p\u003e\n \u003cp\u003e1.54 (0.78-3.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e3.85 (2.45-6.05)**\u003c/p\u003e\n \u003cp\u003e3.28 (2.16-4.98)**\u003c/p\u003e\n \u003cp\u003e2.92 (1.87-4.54)**\u003c/p\u003e\n \u003cp\u003e6.15 (3.32-11.36)**\u003c/p\u003e\n \u003cp\u003e1.81 (1.00-3.27)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Islam\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Other than Islam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e0.81 (0.53-1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eWork experience\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026lt; 5 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5-10 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026gt; 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e0.98 (0.70-1.38)\u003c/p\u003e\n \u003cp\u003e1.17 (0.80-1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.01 (0.80-1.29)\u003c/p\u003e\n \u003cp\u003e1.10 (0.88-1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eHighest education\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No college degree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;College degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.06 (0.77-1.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eHealthcare facility type\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;PHCs\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hospitals\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.26 (0.87-1.38)\u003c/p\u003e\n \u003cp\u003e0.45 (0.13-1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.19 (0.80-1.78)\u003c/p\u003e\n \u003cp\u003e0.28 (0.12-0.64)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.24 (0.90-1.70)\u003c/p\u003e\n \u003cp\u003e0.33 (0.16-0.68)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eWorked in HIV care\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Never\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Past or current\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e0.57 (0.45-0.73)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e0.49 (0.31-0.78)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e0.54 (0.43-0.68)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eJob description\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Healthcare professional\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Support staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.22 (1.01-1.47)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNA: p\u0026gt;0.25 in bivariate analysis; *p\u0026lt;0.05; **p\u0026lt;0.01\u003c/p\u003e\n\u003cp\u003eAgreeing to \u0026lsquo;unacceptable to test for HIV without consent\u0026rsquo; was negatively associated with discriminating practices (aOR 0.58, 95%CI 0.35-0.96), while believing there were repercussions for discriminating against HIV was positively associated (aOR 2.40, 95%CI 1.04-5.54). Having any stigmatising attitude was also a positive predictor (aOR 1.67, 95%CI 1.27-2.22). Other covariates significantly associated with discriminatory practices included province (positive association) and experience working in HIV care as (negative association).\u003c/p\u003e\n\u003cp\u003eTable 4. Multivariable model for social contexts and other factors associated with discriminatory practices.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare professionals (n=1,219)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eaOR, 95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial contexts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eWitnessed coworkers discriminating PLHIV/key population\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.41 (0.93-2.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eUnacceptable to test HIV without consent\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Disagree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e0.58 (0.35-0.96)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eRepercussions for discriminating PLHIV\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Disagree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e2.40 (1.04-5.54)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCovariates\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAny stigmatising beliefs or attitude\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.67 (1.27-2.22)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAge (each incremental year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.98 (0.96-1.00)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eSex \u0026amp; gender\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Female and others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eProvince\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Jakarta\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;West Java\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Central Java\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;East Java\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;North Sumatra\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;South Sulawesi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e2.45 (1.14-5.25)**\u003c/p\u003e\n \u003cp\u003e4.49 (2.22-9.08)**\u003c/p\u003e\n \u003cp\u003e5.45 (2.70-11.00)**\u003c/p\u003e\n \u003cp\u003e1.37 (0.54-3.48)\u003c/p\u003e\n \u003cp\u003e2.77 (1.32-5.84)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Islam\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Other than Islam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e0.73 (0.46-1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eWork experience\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026lt; 5 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5-10 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026gt; 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e1.04 (0.74-1.45)\u003c/p\u003e\n \u003cp\u003e1.12 (0.74-1.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eHighest education\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No college degree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;College degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eHealthcare facility type\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;PHCs\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hospitals\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eWorked in HIV care\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Never\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Past or current\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003cp\u003e0.74 (0.56-0.98)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNA: p\u0026gt;0.25 in bivariate analysis; *p\u0026lt;0.05; **p\u0026lt;0.01\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eTo our knowledge, this study is one of the first to explore HIV stigma and discrimination in the Indonesian healthcare setting at a national scale, simultaneously involving multiple districts and provinces. We observe a considerable level of HIV stigma and discrimination among healthcare workers, with 62.0% of participants agreeing with at least one stigmatising attitude, including 20.2% agreeing that PLHIV women should be sterilised. Among healthcare professionals, 36.8% reported having engaged in HIV discrimination in the form of unnecessary precaution. Localities outside of Jakarta (used as the reference group) was found to be the most salient factor positively associated with stigma and discrimination. Other social contexts, such as witnessing HIV discrimination by coworkers or perceived norms, were also found as predictors, although the direction and effect size were inconsistent across models.\u003c/p\u003e \u003cp\u003eThis finding highlights the gap between Indonesia's aim for zero HIV discrimination and the reality in the field. While the 36.8% proportion of self-reported discriminatory practice that we observed is lower than past local studies in Gunung Kidul in 2022 (over 90%) or in Bandung in 2025 (between 38\u0026ndash;55%),\u003csup\u003e8, 9\u003c/sup\u003e it is unknown if it represents a real progress in stigma reduction or inter-localities variance. The latter is especially likely considering the salience of localities as a predictor in our study.\u003c/p\u003e \u003cp\u003eThis is evident by the salience of geographical disparity for stigma and discrimination. Participants in North Sumatra were found to be significantly more likely to express stigmatising attitude than those in Jakarta. Similarly, participants in East Java were more likely to self-report discriminatory practices. Analyses of a 2017 nationwide community-based survey found that people in Sumatra reported higher HIV stigma compared to Java, a similar pattern to our observation, corroborating the suggestion that structural factors affect the localities of competence and meaning of HIV stigma among healthcare workers.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e While not direct evidence, it suggests a salience of structural factors within localities as an element of habitus that were not captured by our social context variables: witnessing discrimination or perceived norms included in our model.\u003c/p\u003e \u003cp\u003ePrevious studies provide hints of these structural factors. One potential structural factor was regional variation of social and religious norms as reported by a 2021 qualitative study which linked HIV stigma with perceived opposition to social and religious norms.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Another potential structural factor was training curricula as a 2022 study among healthcare trainees reported differences in stigmatising attitudes not only based on geography, but also between different schools and professional training.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e While structural in nature, these factors shaped the localities where practices were situated and habitues were formed, which consequently shaped how stigma and discrimination were reproduced in each geographical setting.\u003c/p\u003e \u003cp\u003eOur findings also reveal a paradox. Perceiving a norm of repercussions against discrimination was associated with a greater likelihood of engaging in unnecessary precautions, while perceiving a norm against testing without consent predicted less discrimination. This is similar to a 2022 local Indonesian study showing a history of HIV training as a positive predictor of intention to avoid providing care for PLHIV.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e This suggests a misalignment between the embodied norms within the habitus and localities of participants and the formal standards that define discrimination. Unnecessary extra precaution, which was how we defined discrimination in this study, may register as professional diligence rather than discrimination among participants due to misconceptions about HIV transmission risks.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAnother interesting finding is that a history of working in HIV services was consistently shown as a negative predictor for HIV stigma and discrimination. This has also been consistently shown in previous Indonesian studies.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Similar findings have also been observed in China, Taiwan, and Nigeria.\u003csup\u003e\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Specialised HIV units may have higher awareness of stigma and discrimination. As localities, they may have had their own norms which discourages HIV stigma and discrimination. Our findings and past studies show that healthcare workers exposed to experiences in these HIV unit localities may carry it to their new workplaces.\u003csup\u003e\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eChanging the habitus of HIV stigma and discrimination as a social practice requires changes to the competences and meanings associated with these practices in the localities where it was practised.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Measures should be taken to counteract the embedded stigma against HIV and key populations in the wider society so that the healthcare system can be a safe space for PLHIV and other HIV-affected communities. It aligns with global strategies calling for public health reforms and accountability against stigma and discrimination.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Hand in hand, competence on HIV knowledge and patient rights should also be built to align anti-discrimination norms with best practices regarding non-discriminatory HIV care.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Evidence from our findings and past studies showed that exposure to HIV services was able to impart both HIV knowledge and build empathy toward HIV-affected communities.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e This could be scaled up in the form of experiential training operationalised through clinical rotations, integrated into formal curricula for healthcare professionals\u0026rsquo; formal training, or continuing professional education.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe strengths of our study were its national scope, one of the first for Indonesia, and our focus on social and policy frameworks. On the other hand, our findings should be seen with acknowledgment of their limitations. Increasing awareness of HIV stigma may have led to some social desirability bias. Although comparable to some past studies,\u003csup\u003e8, 18, 19\u003c/sup\u003e our measure of HIV stigma and discrimination was very specific and may not have accounted for other forms of discrimination described in prior Indonesian qualitative studies.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Similar national-level studies with a more robust measurement framework should be routinely conducted in Indonesia to monitor the trend of HIV stigma and discrimination.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis national-scale study highlights that HIV stigma and discrimination remain prevalent among healthcare workers in Indonesia, with significant variation across provinces, suggesting the salience of both structural and social factors. Key predictors identified include provincial differences, social contexts, and professional experience within HIV services, the latter consistently reducing stigmatising attitudes. Our findings reinforce the need for targeted interventions addressing both the social and structural drivers of stigma, including broader societal norms and localised habitus. Efforts should prioritise integrating anti-discrimination principles and comprehensive HIV education into healthcare training and ongoing professional development. Continued national-level monitoring using robust measurement frameworks is essential to track progress and inform policy, aligning with global strategies to end HIV-related inequalities and discrimination.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe protocol of this study was reviewed, and ethical clearance has been obtained from Research Ethics Committee of the Faculty of Medicine, Udayana University with document number 2451/UN14.2.2.VII.14/LT/2023\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003ePPJ, BDKW, NPAH, KD, NKS, and BO were responsible for the study conception and design. Data collection was organised by BDKW, NPAH, NKS, KD, and BO. Data analysis and the first draft of the manuscript were prepared by GBSW. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eParts of this work were supported by UNAIDS as part of their work supporting the Indonesian national HIV program.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eDeidentified data and codes are available upon reasonable request to the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUNAIDS. (2021). \u003cem\u003eGlobal AIDS Strategy 2021\u0026ndash;2026: End Inequalities, End AIDS\u003c/em\u003e. Joint United Nations Programme on HIV/AIDS (UNAIDS).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNAIDS. (2021). \u003cem\u003eEnding Inequalities and Getting on Track to End AIDS by 2030\u003c/em\u003e. Joint United Nations Programme on HIV/AIDS.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIndonesian Ministry of Health. (2023). \u003cem\u003eMinister of Health Regulation Number 23 of 2022 on the Management of Human Immunodeficiency Virus, Acquired Immuno-Deficiency Syndrome, and Sexually Transmitted Infection\u003c/em\u003e. Ministry of Health.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIndonesian Ministry of Health (2020). Strategic Action Plan for Prevention of HIV and STIs in Indonesia 2020\u0026ndash;2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://hivaids-pimsindonesia.or.id/download/file/RAN_AIDS_2024.pdf\u003c/span\u003e\u003cspan address=\"https://hivaids-pimsindonesia.or.id/download/file/RAN_AIDS_2024.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e accessed 31 March 2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWirawan, G. B. S., Gustina, N. L. Z., \u0026amp; Januraga, P. P. (2022). Open Communication About Reproductive Health Is Associated With Comprehensive HIV Knowledge and a Non-stigmatising Attitude Among Indonesian Youth: A Cross-sectional Study. \u003cem\u003eJ Prev Med Public Health\u003c/em\u003e, \u003cem\u003e55\u003c/em\u003e, 342\u0026ndash;350. 2022/08/09\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSudastri, N. K., Wulandari, L. P. L., \u0026amp; Januraga, P. P. (2025). Manifestation and Markings of HIV Stigma in Indonesia: A Scoping Review. \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e ; 22 2025/06/26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph22060840\u003c/span\u003e\u003cspan address=\"10.3390/ijerph22060840\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJaringan Indonesia Positif. (2024). \u003cem\u003ePeople Living with HIV Stigma Index 2.0 in Indonesia\u003c/em\u003e. Jaringan Indonesia Positif.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLangi, G. G., Rahadi, A., Praptoraharjo, I., et al. (2022). HIV-related stigma and discrimination among health care workers during early program decentralization in rural district Gunungkidul, Indonesia: a cross-sectional study. \u003cem\u003eBmc Health Services Research\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e, 356. 2022/03/19\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilandika, A., Sajodin, Rohmah, S. F., et al. (2025). Stigma Toward Patients Living With HIV Among Nurses Within Public Hospital in Bandung, Indonesia. \u003cem\u003eAsian Nurs Res (Korean Soc Nurs Sci)\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e, 284\u0026ndash;290. 2025/05/23\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFauk, N. K., Hawke, K., Mwanri, L., et al. (2021). Stigma and Discrimination towards People Living with HIV in the Context of Families, Communities, and Healthcare Settings: A Qualitative Study in Indonesia. \u003cem\u003eInternational Journal Of Environmental Research And Public Health\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph18105424\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18105424\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2021/06/03.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFauk, N. K., Ward, P. R., Hawke, K., et al. (2021). HIV Stigma and Discrimination: Perspectives and Personal Experiences of Healthcare Providers in Yogyakarta and Belu, Indonesia. \u003cem\u003eFront Med (Lausanne)\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e, 625787. 2021/06/01\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlue, S., Shove, E., Carmona, C., et al. (2014). Theories of practice and public health: understanding (un)healthy practices. \u003cem\u003eCritical Public Health\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e, 36\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/09581596.2014.980396\u003c/span\u003e\u003cspan address=\"10.1080/09581596.2014.980396\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuise, A. (2024). Stigma power in practice: Exploring the contribution of Bourdieu's theory to stigma, discrimination and health research. \u003cem\u003eSocial Science And Medicine\u003c/em\u003e, \u003cem\u003e347\u003c/em\u003e, 116774. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.socscimed.2024.116774\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2024.116774\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2024/03/28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiraprasiri, T., Srithanaviboonchai, K., Chariyalertsak, S., et al. (2016). \u003cem\u003eStigma and Discrimination Among Health Care Providers, People Living with HIV and Key Populations in Thailand: Extrapolation Process for National Estimates\u003c/em\u003e. Department of Disease Control, Ministry of Public Health.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArifin, H., Ibrahim, K., Rahayuwati, L., et al. (2022). HIV-related knowledge, information, and their contribution to stigmatization attitudes among females aged 15\u0026ndash;24 years: regional disparities in Indonesia. \u003cem\u003eBmc Public Health\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e, 637. 2022/04/03\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFauk, N. K., Ward, P. R., Hawke, K. (2021). Cultural and religious determinants of HIV transmission: A qualitative study with people living with HIV in Belu and Yogyakarta, Indonesia. \u003cem\u003ePLoS One\u003c/em\u003e ; 16: e0257906. 2021\u003cdiv class=\"ExternalRefDOI\"\u003e/11/16\u003c/div\u003e. DOI: 10.1371/journal.pone.0257906.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaluyo, A., Mansyur, M., Earnshaw, V. A., et al. (2022). Exploring HIV stigma among future healthcare providers in Indonesia. \u003cem\u003eAids Care\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e, 29\u0026ndash;38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/09540121.2021.1897777\u003c/span\u003e\u003cspan address=\"10.1080/09540121.2021.1897777\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2021/03/16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToh, H. S., Ku, H. C., Chen, W. P. (2025). Towards zero discrimination: a survey on HIV-related stigma and discrimination among healthcare providers in a medical center in Southern Taiwan. \u003cem\u003eSex Health\u003c/em\u003e ; 22 2025/09/22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1071/SH24172\u003c/span\u003e\u003cspan address=\"10.1071/SH24172\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJia, S., Yue, C., Zhang, L., et al. (2025). HIV/AIDS-related stigma and discrimination among healthcare providers in Western China: a population-based cross-sectional study. \u003cem\u003eBmc Infectious Diseases\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e, 951. 2025/07/29\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalal, Y. S., Khairy, W. A., Mohamed, R., et al. (2022). HIV-related stigma and discrimination by healthcare workers in Egypt. \u003cem\u003eTransactions Of The Royal Society Of Tropical Medicine And Hygiene\u003c/em\u003e, \u003cem\u003e116\u003c/em\u003e, 636\u0026ndash;644. 2022/01/10\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNAIDS. (2025). \u003cem\u003eDraft recommendations - Global Task Team for Setting 2030 HIV Targets\u003c/em\u003e. Joint United Nations Programme on HIV/AIDS.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMak, W. W., Cheng, S. S., Law, R. W., et al. (2015). Reducing HIV-related stigma among health-care professionals: a game-based experiential approach. \u003cem\u003eAids Care\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e, 855\u0026ndash;859. 2015/02/12\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HIV, stigma, discrimination, social practice, Indonesia","lastPublishedDoi":"10.21203/rs.3.rs-8380565/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8380565/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eDespite 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe 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\u0026thinsp;=\u0026thinsp;6.15, 95%CI\u0026thinsp;=\u0026thinsp;3.32\u0026ndash;11.36) and East Java for discrimination (aOR\u0026thinsp;=\u0026thinsp;5.45, 95%CI\u0026thinsp;=\u0026thinsp;2.70\u0026ndash;11.00). History of working in HIV services was a consistent negative predictor (aOR\u0026thinsp;=\u0026thinsp;0.54, 95%CI\u0026thinsp;=\u0026thinsp;0.43\u0026ndash;0.68 for stigma; aOR\u0026thinsp;=\u0026thinsp;0.74, 95%CI\u0026thinsp;=\u0026thinsp;0.56\u0026ndash;0.98 for discrimination).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWe 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.\u003c/p\u003e","manuscriptTitle":"Social Context, HIV Stigma, and Discrimination in Indonesian Healthcare Settings: a National Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 12:16:11","doi":"10.21203/rs.3.rs-8380565/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"06c9cf73-dcf9-48ff-97ab-b04907d56314","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-01T17:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 12:16:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8380565","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8380565","identity":"rs-8380565","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}