title: Stigma Reduction Training Improves Healthcare Provider Attitudes Toward, and Experiences of, Young Marginalized People in Bangladesh.
abstract: OBJECTIVE
  Working with health providers to reduce HIV stigma in the healthcare setting is an important strategy to improve service utilization and quality of care, especially for young people who are sexually active before marriage, are sexual minorities, or who sell sex. A stigma reduction training program for health providers in Bangladesh was evaluated.
  
  
  METHODS
  A cohort of 300 healthcare providers were given a self-administered questionnaire, then attended a 2-day HIV and sexual and reproductive health and rights training (including a 90-minute session on stigma issues). Six months later, the cohort repeated the survey and participated in a 1-day supplemental training on stigma, which included reflection on personal values and negative impacts of stigma. A third survey was administered 6 months later. A cross-sectional survey of clients age 15-24 years was implemented before and after the second stigma training to assess client satisfaction with services.
  
  
  RESULTS
  Provider agreement that people living with HIV should be ashamed of themselves decreased substantially (35.3%-19.7%-16.3%; p < .001), as did agreement that sexually active young people (50.3%-36.0%-21.7%; p < .001) and men who have sex with men (49.3%-38.0%-24.0%; p < .001) engage in "immoral behavior." Young clients reported improvement in overall satisfaction with services after the stigma trainings (63.5%-97.6%; p < .001).
  
  
  CONCLUSIONS
  This study indicates that a targeted stigma reduction intervention can rapidly improve provider attitudes and increase service satisfaction among young people. More funding to scale up these interventions is needed.
authors.affiliation: Population Council, Washington, DC. Electronic address: sgeibel@popcouncil.org.
authors.forename: Scott
authors.initials: S
authors.lastname: Geibel
authors.affiliation: Population Council, Dhaka, Bangladesh.
authors.forename: Sharif M I
authors.initials: SM
authors.lastname: Hossain
authors.affiliation: Population Council, Washington, DC.
authors.forename: Julie
authors.initials: J
authors.lastname: Pulerwitz
authors.affiliation: Population Council, Dhaka, Bangladesh.
authors.forename: Nargis
authors.initials: N
authors.lastname: Sultana
authors.affiliation: Population Council, Dhaka, Bangladesh.
authors.forename: Tarik
authors.initials: T
authors.lastname: Hossain
authors.affiliation: Population Council, Dhaka, Bangladesh.
authors.forename: Shongkour
authors.initials: S
authors.lastname: Roy
authors.affiliation: Population Council, Washington, DC.
authors.forename: Brady
authors.initials: B
authors.lastname: Burnett-Zieman
authors.affiliation: Watipa Community Interest Company, London, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Stackpool-Moore
authors.affiliation: Population Council, New York, New York.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Friedland
authors.affiliation: Marie Stopes Bangladesh, Dhaka, Bangladesh.
authors.forename: Reena
authors.initials: R
authors.lastname: Yasmin
authors.affiliation: International HIV/AIDS Alliance, Dhaka, Bangladesh.
authors.forename: Najmus
authors.initials: N
authors.lastname: Sadiq
authors.affiliation: Population Council, Washington, DC.
authors.forename: Eileen
authors.initials: E
authors.lastname: Yam
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001459:Bangladesh; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000523:psychology; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D046269:Reproductive Rights / Q000193:education*; D011477:Sex Work / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000523:psychology; D057545:Social Stigma; D013240:Stereotyping; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Discrimination; HIV; Healthcare provider training; Key populations; Service provision; Stigma; Young people; Youth