# Knowledge, Attitudes, and Stigma Towards People Living with HIV: An Explanatory Sequential Mixed-Methods Study Among 1013 Healthcare Professionals in Spain

## TL;DR

Spanish healthcare professionals have good HIV knowledge but lack training, leading to fear and subtle stigma, which can be addressed through structured education and training.

## Contribution

This study integrates mixed methods to show that knowledge alone is insufficient to reduce HIV-related stigma among healthcare professionals.

## Key findings

- High factual knowledge about HIV exists, but over half of professionals feel unprepared due to insufficient training.
- Fear of contagion and subtle stigmatizing behaviors persist despite positive attitudes, driven by lack of training and cultural biases.
- Integrated analysis shows a gap between theoretical knowledge and clinical confidence, highlighting the need for targeted education.

## Abstract

What are the main findings?
Healthcare professionals in Spain show high factual knowledge about HIV transmission and treatment, yet more than half report insufficient training and feel unprepared to care for people living with HIV.Despite generally positive attitudes, fear of contagion and subtle stigmatizing behaviors persist, driven mainly by lack of training and cultural prejudices.

Healthcare professionals in Spain show high factual knowledge about HIV transmission and treatment, yet more than half report insufficient training and feel unprepared to care for people living with HIV.

Despite generally positive attitudes, fear of contagion and subtle stigmatizing behaviors persist, driven mainly by lack of training and cultural prejudices.

What are the implications of the main findings?
Adequate knowledge alone is insufficient to eliminate HIV-related stigma in healthcare settings; structured and continuous training is essential to translate knowledge into stigma-free practice.Targeted educational interventions, interprofessional training, and institutional commitment are key to improving the quality, equity, and humanization of care for people living with HIV.

Adequate knowledge alone is insufficient to eliminate HIV-related stigma in healthcare settings; structured and continuous training is essential to translate knowledge into stigma-free practice.

Targeted educational interventions, interprofessional training, and institutional commitment are key to improving the quality, equity, and humanization of care for people living with HIV.

Background/Objectives: Stigma and fear related to human immunodeficiency virus persist in healthcare settings and negatively influence professionals’ attitudes and the quality of care provided to people living with human immunodeficiency virus. This study aimed to evaluate knowledge, attitudes, and stigma toward people living with human immunodeficiency virus among healthcare professionals in Spain and to explore strategies to reduce stigma. Methods: An explanatory sequential mixed-methods study was conducted. In the quantitative phase, an online questionnaire based on the International Planned Parenthood Federation instrument was disseminated nationwide through social media using non-probability convenience sampling. Quantitative data from 1013 healthcare professionals were analyzed using descriptive statistics and non-parametric tests (Kruskal–Wallis, chi-square, Friedman) with appropriate corrections for multiple comparisons. In the qualitative phase, 12 participants were purposively selected for semi-structured interviews to explain quantitative findings. Qualitative data were analyzed using reflexive thematic analysis. Integration occurred through joint interpretation and a joint display table connecting quantitative patterns with qualitative themes. Ethical approval was obtained from the Clinical Research Ethics Committee of Bellvitge Hospital in Catalonia. Results: A total of 1013 healthcare professionals from diverse specialties participated, and twelve completed qualitative interviews. Knowledge regarding transmission, prevention, and treatment of human immunodeficiency virus was high. However, more than half reported no specific training and felt unprepared to care for people living with human immunodeficiency virus. Despite knowledge, fear of contagion was common. Attitudes were positive, with acceptance of caring for people living with human immunodeficiency virus and rejection of common misconceptions. Qualitative findings revealed persistent stigma linked to insufficient training and cultural prejudice. Integration of quantitative and qualitative data revealed that knowledge alone does not eliminate fear, and that the gap between theoretical understanding and clinical confidence represents a critical barrier to stigma-free care. Conclusions: Although healthcare professionals in Spain demonstrate knowledge about human immunodeficiency virus, stigma and fear remain prevalent. Targeted education and interprofessional training are needed to ensure respectful, inclusive, and stigma-free clinical care.