title: The role of people living with HIV as patient instructors - reducing stigma and improving interest around HIV care among medical students.
abstract: People living with HIV/AIDS (PHAs) are increasingly recognized as experts in HIV and their own health. We developed a simulated clinical encounter (SCE) in which medical students provided HIV pre- and post-test counselling and point-of-care HIV testing for PHAs as patient instructors (PHA-PIs) under clinical preceptor supervision. The study assessed the acceptability of this teaching tool with a focus on assessing impact on HIV-related stigma among medical students. University of Toronto pre-clerkship medical students participated in a series of SCEs facilitated by 16 PHA-PIs and 22 clinical preceptors. Pre- and post-SCE students completed the validated Health Care Provider HIV/AIDS Stigma Scale (HPASS). HPASS measures overall stigma, as well as three domains within HIV stigma: stereotyping, discrimination, and prejudice. Higher scores represented higher levels of stigma. An additional questionnaire measured comfort in providing HIV-related care. Mean scores and results of paired t-tests are presented. Post-SCE, students (n   =   62) demonstrated decreased overall stigma (68.74 vs. 61.81, p   <   .001) as well as decreased stigma within each domain. Post-SCE, students (n   =   67) reported increased comfort in providing HIV-related care (10.24 vs. 18.06, p   <   .001). Involving PHA-PIs reduced HIV-related stigma among medical students and increased comfort in providing HIV-related care.
authors: a Faculty of Medicine , University of Toronto , Toronto , ON , Canada.
authors: Denise
authors: D
authors: Jaworsky
authors: b Ontario HIV Treatment Network , Toronto , ON , Canada.|c Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada.
authors: Sandra
authors: S
authors: Gardner
authors: a Faculty of Medicine , University of Toronto , Toronto , ON , Canada.
authors: Julie G
authors: JG
authors: Thorne
authors: d Department of Infectious Diseases , University of Toronto , Toronto , ON , Canada.
authors: Malika
authors: M
authors: Sharma
authors: e Standardized Patient Program , University of Toronto , Toronto , ON , Canada.
authors: Nancy
authors: N
authors: McNaughton
authors: f Toronto People With AIDS Foundation , Toronto , ON , Canada.
authors: Suzanne
authors: S
authors: Paddock
authors: a Faculty of Medicine , University of Toronto , Toronto , ON , Canada.
authors: Derek
authors: D
authors: Chew
authors: g Nine Circles Community Health Centre , Winnipeg , MB , Canada.
authors: Rick
authors: R
authors: Lees
authors: f Toronto People With AIDS Foundation , Toronto , ON , Canada.
authors: Tutsirai
authors: T
authors: Makuwaza
authors: h Department of Psychology , Ryerson University , Toronto , ON , Canada.
authors: Anne
authors: A
authors: Wagner
authors: i Sunnybrook Health Sciences Centre , Toronto , ON , Canada.|j Faculty of Medicine , University of Toronto , Toronto , ON , Canada.
authors: Anita
authors: A
authors: Rachlis
authors: k Collaboration for HIV Medical Education , Toronto , ON , Canada.
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis; D006801:Humans; D008297:Male; D016544:Patient Simulation; D019095:Point-of-Care Systems; D011287:Prejudice; D057545:Social Stigma; D013240:Stereotyping; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: HIV/AIDS; Medical education; community-based research; stigma; testing and counselling