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

Out-of-date HIV knowledge among healthcare workers (HCW) can hinder the quality of care for people with HIV (PWH) and contribute to stigmatizing attitudes and behaviors.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 multi-racial (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.