PERSEPSI TENAGA KESEHATAN TERHADAP PENANGANAN KASUS HIV/AIDS DI FASILITAS KESEHATAN PRIMER: STUDI ETNOGRAFI TENTANG HAMBATAN KOMUNIKASI DAN KONSELING
HEALTHCARE WORKERS' PERCEPTIONS OF HIV/AIDS CASE MANAGEMENT IN PRIMARY HEALTH CARE FACILITIES: AN ETHNOGRAPHIC STUDY ON COMMUNICATION AND COUNSELING BARRIERS
Abstract
Penelitian ini mengeksplorasi persepsi tenaga kesehatan terhadap penanganan kasus HIV/AIDS di fasilitas kesehatan primer, dengan fokus pada hambatan komunikasi dan konseling. Menggunakan pendekatan etnografi selama empat bulan di tiga puskesmas di Jawa Barat, data dikumpulkan melalui observasi partisipan (120 jam), wawancara mendalam dengan 24 tenaga kesehatan, dan analisis dokumen. Hasil penelitian menunjukkan tiga hambatan utama: (1) kecanggungan komunikasi tentang perilaku berisiko (83,3% tenaga kesehatan merasa canggung), (2) konseling pasca-tes yang dangkal (80% hanya memberikan rujukan tanpa dukungan emosional), dan (3) stigma multidimensi yang meliputi stigma interaksional (54% menghindari kontak mata), struktural (100% puskesmas tidak memiliki ruang konseling privat), dan internal (41,7% merasa tidak pantas merawat ODHIV). Hambatan-hambatan ini membentuk lingkaran setan yang menyebabkan tingginya angka loss to follow-up (47%). Penelitian ini menyimpulkan bahwa hambatan komunikasi dan konseling bukanlah masalah teknis semata, melainkan masalah kultural dan struktural yang membutuhkan intervensi pelatihan berbasis etnografi, penyediaan infrastruktur, serta dukungan psikologis bagi tenaga kesehatan.
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2. Bateganya, M., Amanyeiwe, U., Roxo, U., & Dong, M. (2015). Impact of support groups for people living with HIV on clinical outcomes: A systematic review of the literature. Journal of Acquired Immune Deficiency Syndromes, 68(Suppl 3), S368–S374. doi: 10.1097/QAI.0000000000000519
3. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. doi: 10.1191/1478088706qp063oa
4. Braun, V., & Clarke, V. (2021). Thematic analysis: A practical guide. SAGE Publications.
5. Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). SAGE Publications.
6. Deblonde, J., De Koker, P., Hamers, F. F., Fontaine, J., Luchters, S., & Temmerman, M. (2010). Barriers to HIV testing in Europe: A systematic review. European Journal of Public Health, 20(4), 422–432. doi: 10.1093/eurpub/ckp231
7. Dovidio, J. F., Major, B., & Crocker, J. (2000). Stigma: Introduction and overview. In T. F. Heatherton, R. E. Kleck, M. R. Hebl, & J. G. Hull (Eds.), The social psychology of stigma (pp. 1–28). Guilford Press.
8. Earnshaw, V. A., & Chaudoir, S. R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13(6), 1160–1177. doi: 10.1007/s10461-009-9593-3
9. Genberg, B. L., Hlavka, Z., Konda, K. A., Maman, S., Chariyalertsak, S., Chingono, A., Mbwambo, J., Modiba, P., Van Rooyen, H., & Celentano, D. D. (2009). A comparison of HIV/AIDS-related stigma in four countries: Negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS. Social Science & Medicine, 68(12), 2279–2287. doi: 10.1016/j.socscimed.2009.04.005
10. Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall.
11. Hidayat, J., Chen, M. Y., Maulina, R., & Nurbaya, S. (2023). Factors associated with HIV-related stigma among Indonesian healthcare workers: A cross-sectional online survey. The Journal of Nursing Research, 31(5), e294. doi: 10.1097/jnr.0000000000000573
12. Joint United Nations Programme on HIV/AIDS. (2021). Global AIDS strategy 2021–2026: End inequalities, end AIDS. UNAIDS.
13. Joint United Nations Programme on HIV/AIDS. (2024). The urgency of now: AIDS at a crossroads. UNAIDS.
14. Joint United Nations Programme on HIV/AIDS. (2025). Global HIV & AIDS statistics: Fact sheet. UNAIDS.
15. Kementerian Kesehatan Republik Indonesia. (2019). Pedoman nasional pelayanan kedokteran: Tata laksana HIV. Kementerian Kesehatan Republik Indonesia.
16. Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. University of California Press.
17. Kumar, R., & Sharma, M. (2024). Cultural barriers in HIV communication and counseling among marginalized communities: An ethnographic perspective. Journal of Health Communication, 29(2), 115–126.
18. Li, L., Liang, L. J., Lin, C., Wu, Z., & Rotheram-Borus, M. J. (2013). HIV prevention intervention to reduce HIV-related stigma: Evidence from China. AIDS, 27(Suppl 2), S115–S122. doi: 10.1097/QAD.0000000000000075
19. Li, Z., Sheng, Y., Liu, H., Chen, X., & Luo, X. (2018). HIV-related stigma among healthcare providers in China: A systematic review and meta-analysis. BMC Public Health, 18, 745. doi: 10.1186/s12889-018-5659-6
20. Mahendra, V. S., Gilborn, L., Bharat, S., Mudoi, R., Gupta, I., George, B., Samson, L., Daly, C., & Pulerwitz, J. (2007). Understanding and measuring AIDS-related stigma in health care settings: A developing country perspective. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 4(2), 616–625. doi: 10.1080/17290376.2007.9724883
21. Nyblade, L., Stangl, A., Weiss, E., & Ashburn, K. (2009). Combating HIV stigma in health care settings: What works? Journal of the International AIDS Society, 12, 15. doi: 10.1186/1758-2652-12-15
22. Nyblade, L., Stockton, M. A., Giger, K., Bond, V., Ekstrand, M. L., McLean, R., Mitchell, E. M. H., Nelson, L. R. E., Sapag, J. C., Siraprapasiri, T., Turan, J., & Wouters, E. (2019). Stigma in health facilities: Why it matters and how we can change it. BMC Medicine, 17, 25. doi: 10.1186/s12916-019-1256-2
23. O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine, 89(9), 1245–1251. doi: 10.1097/ACM.0000000000000388
24. Pulerwitz, J., Michaelis, A., Weiss, E., Brown, L., & Mahendra, V. S. (2010). Reducing HIV-related stigma: Lessons learned from Horizons research and programs. Public Health Reports, 125(2), 272–281. doi: 10.1177/003335491012500218
25. Rueda, S., Mitra, S., Chen, S., Gogolishvili, D., Globerman, J., Chambers, L., Wilson, M., Logie, C. H., Shi, Q., Morassaei, S., & Rourke, S. B. (2016). Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: A series of meta-analyses. BMJ Open, 6(7), e011453. doi: 10.1136/bmjopen-2016-011453
26. Spradley, J. P. (1980). Participant observation. Holt, Rinehart and Winston.
27. Stangl, A. L., Lloyd, J. K., Brady, L. M., Holland, C. E., & Baral, S. (2013). A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013. Journal of the International AIDS Society, 16(3 Suppl 2), 18734. doi: 10.7448/IAS.16.3.18734
28. Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. doi: 10.1093/intqhc/mzm042
29. Waluyo, A., Culbert, G. J., Levy, J., & Norr, K. F. (2015). Understanding HIV-related stigma among Indonesian nurses. Journal of the Association of Nurses in AIDS Care, 26(1), 69–80. doi: 10.1016/j.jana.2014.03.001
30. World Health Organization. (2021). Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: Recommendations for a public health approach. World Health Organization.
31. World Health Organization. (2024). Consolidated guidelines on differentiated HIV testing services. World Health Organization.
32. Wilandika, A. (2018). Health care provider stigma on people living with HIV/AIDS (PLWHA) in Bandung. Jurnal Keperawatan, 10(1), 7–15. doi: 10.22219/jk.v10i1.6321
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2026-07-22
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