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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Frontline: Realities of stigma in health care settings

by HDN Key Correspondent, Uganda
August 2006

While the majority of health care professionals comply with ethical guidelines and do not deny care or treatment to people living with HIV (PLHIV), a disturbing number of health care professionals engage in stigmatising and discriminatory behaviour, according to studies presented at the recent XVI International AIDS Conference in Toronto.

Health care workers are also reported to engage in practices that contravene codes of professional ethics, including HIV testing without consent and disclosure of confidential medical information without prior permission. This was revealed by Takawira Moses, who works with Medicin Sans Frontiers (MSF) in rural Zambia.

It is clear that the health sector is not immune to HIV-related stigma or discrimination, which is reported to be ‘rampant’ in many communities where HIV is still seen as taboo. This is a serious impediment for many PLHIVs coming forward to receive much needed treatment, care and support services, and to disclosing their status and fully facing the virus.

According to research findings presented by JS Oruko, conducted in four districts hospitals and eight rural health units in Kenya, the lack of adequate knowledge and lack of universal precautions to protect health workers, such as gloves, adequate sharps disposal and post-exposure prophylaxis, contributes to the formation of stigmatising attitudes among health workers, who themselves fear infection.

“The fear they face affects the kind of treatment given to the PLHIV”, said Oruko.

This underscores the need for a comprehensive plan to develop the health systems of resource limited counties so that health workers have enough knowledge and basic equipment to protect themselves while caring for their patients.

The uneven distribution of knowledge, care competence and basic resources between urban and rural settings also means that stigmatising attitudes tend to be highest in rural health care. This surely suggests that poverty is also one of the underlying factors in creating HIV-related stigma.

According to Dr Katende from Uganda, who has provided technical expertise in developing tools to measure stigma, a considerable number of health workers admit to having refused to care for or admit people with HIV. There are cases where health workers express sentiments like: “Treatment of opportunistic infections in PLHIV is wastage of valuable resources.”

It is appalling that among the health workers, the three most important concerns about treating HIV-positive patients are fear of becoming infected, contamination of the health facility and lack of availability of materials and instruments needed for treatment, as is revealed through a report from Nigeria by Physicians for Human Rights.

One way to reassure health workers working with PLHIVs is provision of post-exposure prophylaxis (PEP) to treat possible cases of nosocomial infection through, for example, needlestick injuries. To some health workers PEP is still a mystery, particularly those working in rural settings. But where PEP is available it provides health care workers with the reassurance that in case of accidental exposure – which is very rare – something can nevertheless be done.

If we are to reduce and eventually eradicate HIV-related stigma and discrimination in health care settings, we must look very honestly at the realities that health workers face. Their fears are in some ways justified. Provision of support and information is essential to fight the fear that breeds stigma.

HDN Key Correspondent, Uganda

(First distributed: August 2006)