Abstract
<title>Abstract</title> <p>Background HIV and key population-related stigmas are critical barriers to case identification, treatment adherence and retention in care. Healthcare workers may hold stigmatizing attitudes that affect service quality. We estimated the prevalence of HIV and KP attitudinal stigma and associated factors among healthcare workers in Northwest Cameroon. Methods We conducted a multi-center cross-sectional survey from February to May 2025 in four high-volume facilities in Northwest Cameroon. HCWs aged ≥ 21 years were recruited via convenience sampling and completed a self-administered electronic questionnaire. Attitudinal stigma was measured using the 9-item attitudes subscale of the Nyblade brief stigma questionnaire. Primary outcome was endorsement of ≥ 1 stigmatizing response for HIV (items 1–5) and KP (items 7–9). Internal consistency was assessed with Cronbach's alpha. Multivariable logistic regression and modified Poisson regression were used to identify factors associated with stigma. Results Of 1,855 eligible HCWs, 670 participated (36.1% response rate). Most were female (80.6%), nurses (69.6%) and worked in urban facilities (87.0%). Prevalence of HIV attitudinal stigma was 63.4% (95% CI: 59.7–67.0, n = 425) and KP stigma 31.2% (95% CI: 27.8–34.8, n = 209). Reproductive rights stigma (women living with HIV should not have children) was 6.4% (4.8–8.5). Most endorsed HIV items were "PLHIV do not care if they infect others" (40.1%) and "have/had many sexual partners" (31.6%). Most endorsed KP item was unwillingness to provide services to men who have sex with men (24.5%). In multivariable analysis, < 5 years experience was associated with HIV stigma (adjusted odds ratio 1.48, 95% CI: 1.01–2.17) versus 5–10 years. Secondary education (aOR 2.02, 1.32–3.09) and cohabiting marital status (aOR 3.37, 1.24–9.13) were associated with KP stigma. Conclusions Attitudinal stigma towards people living with HIV and KPs remains high among HCWs in Northwest Cameroon and is associated with limited work experience and lower education, rather than facility type. Integrating stigma reduction into routine HIV training for all categories of healthcare workers is recommended.</p>