Frontline: Realities of stigma in health care settings
by HDN Key Correspondent, Uganda
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
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)