Association between HIV knowledge and stigma among HIV health care workers in the Dominican Republic: The role of empathy and social distance

Abstract

Abstract: Out-of-date HIV knowledge among health care workers (HCWs) can hinder the quality of care for people with HIV (PWH) and contribute to stigmatizing attitudes and behaviors. However, the role of HIV knowledge on stigma and mechanisms underlying HCWs’ attitudes and behaviors remain understudied. This study examined empathy and social distance as mediators in the relationship between HIV knowledge and stigma toward PWH among HCWs. Cross-sectional data from 219 HCWs were collected at two clinics in the Dominican Republic. Serial mediation analyses examined the indirect effects of HIV knowledge on stigmas (i.e., worry related to contracting HIV, taking additional infection precautions, and moralizing opinions about PWH’s behaviors) through empathy and social distance, adjusting for age and sexual orientation. Mean age was 42.16 years (SD = 11.97). Most participants identified as female (79.9%), heterosexual 68.9%, and multiracial (71.7%). The serial mediation models revealed significant indirect effects, suggesting that insufficient HIV knowledge was associated with less empathy toward PWH (B = 1.92, β = .33, SE = .37, p < .001). Lower empathy, in turn, was associated with greater desire for social distance (B = .15, β = .18, SE = .06, p = .009). Greater social distance was subsequently linked to increased worry related to contracting HIV (B = .13, β = .21, SE = .04, p = .001), taking additional infection precautions (B = .06, β = .14, SE = .03, p = .035), and more moralizing opinions about PWH (B = .11, β = .13, SE = .05, p = .027). Interventions that improve HIV knowledge and foster empathy, thereby possibly reducing the desire for social distance from PWH among HCWs, should be explored to test their potential to mitigate HIV stigma and enhance care outcomes for PWH.

Impact statement: Health care workers with outdated HIV knowledge may unintentionally contribute to stigma, which can negatively impact care for people with HIV (PWH). This study suggests that improving HIV knowledge among health care workers is associated with empathy, reduces social distance, and diminishes stigmatizing attitudes and behaviors toward PWH. These findings suggest the importance of educational interventions that focus on both accurate HIV information and empathy-building to enhance care quality and reduce stigma in health care settings. By addressing these factors, health care organizations can create a more supportive environment for PWH and improve health outcomes.