|
The
Discriminatory Attitudes of Health Workers against People Living
with HIV
Gobopamang
Letamo
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1176246
Gobopamang
Letamo is an assistant representative at United Nations
Population Fund, Botswana Country Office, Gaborone, Botswana.
E-mail:
gobopamang.letamo@undp.org,
E-mail:
letamo@unfpa.org
Anecdotal evidence suggests that
health-care professionals in Nigeria may discriminate against
and stigmatise people living with HIV/AIDS(PLWA). In a study in
the August issue of PLoS Medicine, Reis and colleagues
set out to characterise the nature and extent of discriminatory
practices and attitudes in the health sector, and indicate
possible contributing factors and intervention strategies [1].
The study was specifically designed to answer three research
questions: (1) are there discriminatory practices in the health
sector that affect the health and well-being of PLWA in Nigeria,
(2) how receptive are health workers and institutions to
treating PLWA, and (3) what underlying factors may contribute to
any discriminatory practices?
In
order to answer these questions, a representative sample of
1,103 health-care professionals (doctors, nurses, and midwives)
working directly with patients with HIV/AIDS were selected from
four states in Nigeria and asked to participate in a study. The
response rate was 93% (i.e., 1,021 surveyed professionals
participated). A survey questionnaire was administered to
respondents to collect information about their knowledge,
attitudes, and behaviour. The study was reviewed and approved by
an independent ethics review board of individuals with expertise
in clinical medicine, public health, bioethics, and
international HIV/AIDS and human rights research
Main Findings of the Study
The results suggest that some health-care
professionals discriminate against and stigmatise PLWA. For
instance, 9% of professionals reported refusing to care for a
patient with HIV/AIDS, and 9% reported that they refused a
patient with HIV/AIDS admission to hospital. Two-thirds reported
observing other health professionals refusing to care for a
patient with HIV/AIDS, and 43% observed others refusing a
patient with HIV/AIDS admission to hospital.
The study suggests that a significant
number of health-care professionals engage in discriminatory and
unethical behaviour. Some professionals reported giving
confidential information to other people (family members and
unrelated individuals) without the patient's consent. Despite
these discriminatory attitudes, an optimistic finding is that
most health-care professionals expressed an interest in
additional information and suggested education and counselling
as a way to address discriminatory behaviours by their
colleagues.
Myths and misconceptions about HIV
transmission play a role in promoting discrimination.
The study concludes that all clinical staff should be educated
about HIV/AIDS, modes of transmission of the virus, universal
precautions, and the rights of PLWA. Such education is likely to
reduce discriminatory practices towards PLWA and may improve
these patients' care and access to health services. The study
also asserts that a lack of protective materials and other
materials needed to treat and prevent the spread of HIV,
documented in several health facilities and reported by
professionals themselves, contributes to discriminatory
behaviour among health professionals
Implications of the Study
The study raises the possibility (although
does not prove) that patients with HIV/AIDS may not fully
utilise health-care services because they are denied access by
health-care providers who discriminate against them. The fact
that some health workers have discriminated against PLWA in the
past suggests that health-care professionals serving PLWA should
urgently be educated about HIV/AIDS so that they fully
understand how HIV can and cannot be transmitted.
It is clear from Reis and colleagues' study
and others, including my own research in Botswana [2–4],
that myths and misconceptions about how HIV can and cannot be
transmitted play an important role in promoting discrimination.
The implication of these findings is clear—there is a dire need
to strengthen the information, education, and communication
component of HIV/AIDS prevention efforts in order to dispel
misconceptions that people tend to hold.
In my own research in Botswana, I found
that although the prevalence of discriminatory attitudes towards
PLWA may be high, respondents tend to be less discriminating
when the HIV-positive person happens to be a family member [2].
People are reluctant to make the serostatus of their relatives
public when their relatives are HIV positive, for fear of
discrimination.
In
order to further our understanding of the root causes of
discrimination and stigmatisation of PLWA, qualitative research
is needed to understand cognitive processes that lead one to
discriminate. It would also be interesting to investigate how
PLWA feel that they are perceived by people around them. In
order to adequately address issues of discrimination, we must
involve PLWA and find out what they feel needs to be done to
address stigma and discrimination. We also need to investigate
the extent to which researchers are able to measure what they
purport to measure with the current indicators of discrimination
and stigmatisation. It is possible that the prevalence of stigma
and discrimination against PLWA is not being adequately measured
with the research instruments currently in use
References
1.
Reis C, Amowitz LL, Heisler M, Moreland RS, Mafeni JO, et
al. Discriminatory attitudes and practices by health workers
toward patients with HIV/AIDS in Nigeria.
PLoS Med.
2005;2:e246.
2.
Letamo G. Prevalence of, and factors associated with,
HIV/AIDS-related stigma and discriminatory attitudes in
Botswana. J Health
Popul Nutr. 2003;21:347–356.
3.
Letamo G. HIV/AIDS-related stigma and discrimination
among adolescents in Botswana.
Afr Popul Stud.
2004;19:191–203.
4.
Letamo, G. Gender dimensions in misconceptions about HIV/AIDS
prevention and transmission in Botswana [poster]. 25th
International Union for the Scientific Study in Population
Conference; 2005 18–23 July; Tours, France. 2005.
|
