Major change needed to eliminate stigma in Australian healthcare

November 20, 2023

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Stigma in healthcare remains a significant problem in Australia, according to the latest Stigma Indicators Monitoring Project data. 

Since 2016, the Stigma Indicators Monitoring Project from UNSW has collected survey data from several sources to create a snapshot of stigma reported by priority groups. The latest findings have recently been published as part of the Centre for Social Research in Health’s Annual report of trends in behaviour 2023: Viral hepatitis, HIV, STIs and sexual health in Australia. Using data gathered up to 2022, the Stigma Indicators Monitoring Project shows that among surveyed priority population groups, rates of self-reported negative experiences with healthcare workers in the past year due to indicators such as sexual orientation, injecting drug use, and hepatitis C have remained generally stable over time.

In the case of indicators around HIV and sex work, the rate of recent self-reported negative experiences in healthcare decreased. However, for many priority groups the rate of stigma in healthcare remains high: in 2021, 72 per cent of people reported negative treatment by healthcare workers due to injecting drug use, while in 2022 88 per cent of people had recent negative experiences due to engaging in sex work. 

Dr Timothy Broady, Senior Research Fellow at the Centre for Social Research in Health at UNSW and author of the 2023 report on the Stigma Indicators Monitoring Project, points to a number of possible factors behind these stable or downward trends — many of which highlight that statistics alone cannot tell the whole story. While social progress is certainly a possibility, Dr Broady also says that drops in recent negative experiences may also be attributable to patients changing their behaviour to avoid being discriminated against, or larger societal movements (such as the 2018 postal survey on legalising same-sex marriage) causing spikes in discriminatory discourse. 

Among surveyed healthcare workers, trends in stigma-related biases have shown little sign of progress. As of 2022, 70 per cent of surveyed healthcare workers self-reported they would be likely to behave negatively towards someone because of their injecting drug use. Meanwhile, 47 per cent reported they may act negatively towards people because of their engagement in sex work. 

While the data is revealing, it is not the overall trends that are the main takeaway from the report, Dr Broady says, but rather that stigma is experienced at all in healthcare settings.  

“I think really the main take home message isn’t so much about whether [stigma] is going up or whether it’s going down. The problem is the fact that it’s still there and it’s far too common,” says Dr Broady. “That [stigma] continues to be a problem needs to be more front and centre and prioritised in order to improve health outcomes for all affected communities.”  

“Anyone experiencing stigma is too many.” 

– Dr Timothy Broady, Senior Research Fellow at the Centre for Social Research in Health at UNSW

Discrimination in healthcare can create poorer outcomes for patients, with a literature review finding that stigma can result in denial of care, longer wait times, and provision of sub-standard care. Past discrimination can also impact whether patients seek access to medical care in the first place. 

“When people have a negative experience in healthcare, that’s going to impact on their retention in care and accessing the types of services they need,” says Dr Broady.  

“Having past experiences with stigma can then be a barrier. If a person is making the effort to go and seek any kind of healthcare, but in the back of their mind are thinking, ‘I’m going to be treated terribly’ or ‘I have been and I might be again’, that can reduce their willingness to seek out the treatment that they need at any time.” 

So how do we eliminate stigma in health settings so everyone can feel safe and confident accessing the care they need? 

Dr Broady says it’s time we move away from putting the onus on people who experience stigma, and instead direct attention and resources to the health workforce and sustainable structural change. 

UNSW is currently undertaking the Government-funded Universal Precautions project. The project aims to develop a more holistic, systematic approach to eliminating stigma by addressing the intersectional nature of discrimination in healthcare and leveraging health system precepts of equity, access, and quality. By acknowledging that sources of stigma can be varied and overlapping and focusing on stigma as a whole as opposed to individual indicators, Dr Broady says a universal precautions approach offers efficiency and ensures healthcare workers are working without perpetrating stigma regardless of the situation. 

Further discussion on how to implement novel strategies such as this are at the centre of UNSW’s upcoming Tackling Stigma Conference in November 2024. The conference will bring together researchers, people from affected communities, and healthcare workers to exchange knowledge around current and future interventions and next steps to reduce stigma in healthcare. 

While eliminating stigma in Australia’s healthcare sector will be long-term process, there are actions healthcare workers can take now to reduce discrimination in their practice. ASHM’s ‘Stigma and discrimination, no place in healthcare’ video resources highlight real people and their experiences navigating the healthcare system, alongside practical advice to healthcare workers on creating welcoming, inclusive environments for all. ASHM also offers free, on-demand online modules tailored to different healthcare roles, giving healthcare workers the tools to adopt an anti-discriminatory approach at work.  

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