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Attitude of Health-Care Workers to HIV/AIDS
A E Sadah, A O Fawole, W E Sadoh, A O Oladimeji, O S Sotiloye
African Journal of Reproductive Health , 2006,
Abstract: The current 5% prevalence rate of HIV in Nigeria represents a significant population of people living with HIV/AIDS (PLWHA). Discrimination against PLWHA has profound impact on the care and support required fro their optimal management particularly in resource-constrained settings. The study sought to assess the knowledge of health-care providers about HIV/AIDS, determine the potential for discrimination in the provision of services based on patients\' HIV sero-status and review the factors that may contribute to such attitude. Self administered semi-structured questionnaires were administered to respondents who were selected by multi-stage sampling technique. The questionnaires explored the respondents\' knowledge about HIV and their attitude and practice regarding PLWHA. Three hundred and forty-five questionnaires were completed. Only 77.1% correctly identified breastfeeding as a source of HIV transmission; 5.2% and 26% respectively thought transmission was possible through mosquito bite and handshake. About 10% and 15% respectively among trained nurses and auxiliary nurses were unaware that HIV could be transmitted to the child during delivery. Some 13.9% and 12.7% of respondents respectively were unwilling to take vital signs and carry out physical examination on PLWHA. Compared to physicians, trained nurses and auxiliary nurses were more likely to deny services based on HIV ero-status. Negative attitude was more likely if the source of the HIV infection was from homosexual exposure or bisexual indiscretion. The health-care workers studied manifested certain attitudes that are potentially discriminatory of PLWHA well-coordinated continuing education of HIV/AIDS for all categories of health-care workers is recommended as a vital strategy in the crusade against the epidemic. African Journal of Reproductive Health Vol. 10 (1) 2006: pp. 39-46
Combating HIV stigma in health care settings: what works?
Nyblade Laura,Stangl Anne,Weiss Ellen,Ashburn Kim
Journal of the International AIDS Society , 2009, DOI: 10.1186/1758-2652-12-15
Abstract: The purpose of this review paper is to provide information and guidance to those in the health care setting about why it is important to combat HIV-related stigma and how to successfully address its causes and consequences within health facilities. Research shows that stigma and discrimination in the health care setting and elsewhere contributes to keeping people, including health workers, from accessing HIV prevention, care and treatment services and adopting key preventive behaviours. Studies from different parts of the world reveal that there are three main immediately actionable causes of HIV-related stigma in health facilities: lack of awareness among health workers of what stigma looks like and why it is damaging; fear of casual contact stemming from incomplete knowledge about HIV transmission; and the association of HIV with improper or immoral behaviour. To combat stigma in health facilities, interventions must focus on the individual, environmental and policy levels. The paper argues that reducing stigma by working at all three levels is feasible and will likely result in long-lasting benefits for both health workers and HIV-positive patients. The existence of tested stigma-reduction tools and approaches has moved the field forward. What is needed now is the political will and resources to support and scale up stigma-reduction activities throughout health care settings globally.
Validation of an HIV-related stigma scale among health care providers in a resource-poor Ethiopian setting  [cached]
Feyissa GT,Abebe L,Girma E,Woldie M
Journal of Multidisciplinary Healthcare , 2012,
Abstract: Garumma Tolu Feyissa1, Lakew Abebe1, Eshetu Girma1, Mirkuzie Woldie21Department of Health Education and Behavioral Sciences, 2Department of Health Services Management, Jimma University, Jimma, EthiopiaBackground: Stigma and discrimination (SAD) against people living with human immunodeficiency virus (HIV) are barriers affecting effective responses to HIV. Understanding the causes and extent of SAD requires the use of a psychometrically reliable and valid scale. The objective of this study was to validate an HIV-related stigma scale among health care providers in a resource-poor setting.Methods: A cross-sectional validation study was conducted in 18 health care institutions in southwest Ethiopia, from March 14, 2011 to April 14, 2011. A total of 255 health care providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support (PIS) and HIV-related SAD. Exploratory factor analysis (EFA) with principal component extraction and varimax with Kaiser normalization rotation were employed to develop scales for SAD. Eigenvalues greater than 1 were used as a criterion of extraction. Items with item-factor loadings less than 0.4 and items loading onto more than one factor were dropped. The convergent validity of the scales was tested by assessing the association with HIV knowledge, PIS, training on topics related to SAD, educational status, HIV case load, presence of an antiretroviral therapy (ART) service in the health care facility, and perceived religiosity.Results: Seven factors emerged from the four dimensions of SAD during the EFA. The factor loadings of the items ranged from 0.58 to 0.93. Cronbach's alphas of the scales ranged from 0.80 to 0.95. An in-depth knowledge of HIV, perceptions of institutional support, attendance of training on topics related to SAD, degree or higher education levels, high HIV case loads, the availability of ART in the health care facility and claiming oneself as nonreligious were all negatively associated with SAD as measured by the seven newly identified latent factors.Conclusion: The findings in this study demonstrate that the HIV-related stigma scale is valid and reliable when used in resource-poor settings. Considering the local situation, health care managers and researchers may use this scale to measure and characterize HIV-related SAD among health care providers. Tailoring for local regions may require further development of the tool.Keywords: stigma, discrimination, health care providers, HIV
Greater involvement of people living with HIV in health care
Morolake Odetoyinbo,Stephens David,Welbourn Alice
Journal of the International AIDS Society , 2009, DOI: 10.1186/1758-2652-12-4
Abstract: Greater Involvement of People Living with HIV/AIDS represents a mobilising and an organising principle for the involvement of people living with HIV in program and policy responses. People with HIV have been at the forefront of designing and implementing effective HIV treatment, care and prevention activities. However, governments and health systems have yet to act to fully harness the potential and resources of people living with HIV in addressing the epidemic. The lives and experiences of people living with HIV highlight the need for a shift in the existing paradigm of disease management. The high prevalence of HIV amongst health care providers in many countries, exacerbated by stigma towards those with HIV in the health care professions, is seriously undermining the capacity of health systems and signals the need to change the current nature of health care delivery. Moreover, the negative experiences of many people with HIV in relation to their health care as well as in their daily social interactions, coupled with the ever-limited current investment in treatment, care and support, demonstrate that the current system is drastically failing the majority of people with HIV. Current health management systems urgently need to be more effectively maximised, to increase the quality of standards of health care systems and services in resource poor countries. An integrated approach to health care based on a human rights framework, grounded in community realities and delivered in partnership and solidarity with people living with HIV, offers the most viable approach to overcoming the crisis of HIV in the health care system.
Disparity in health care: HIV, stigma, and marginalization in Nepal
Jha Chandra K,Madison Jeanne
Journal of the International AIDS Society , 2009, DOI: 10.1186/1758-2652-12-16
Abstract: Background The provision of effective health care to people with HIV and those from usually marginalised backgrounds, such as drug users and sex workers is a growing concern in Nepal, because these populations often do not seek health care, as willingly as the general population. Exploration of the factors, which hinder them seeking health care is crucial. The 'lived' experiences of the usually marginalized participants in this research will reflect on the constraining factors, and contribute to the development of appropriate strategies, which will facilitate people with HIV and other marginal populations to seek more readily appropriate health services. Methods This study explored the healthcare-seeking experiences of 20 HIV-positive participants in Nepal, as well as 10 drug-using participants who had never had an HIV test and did not know their HIV status. Using grounded theory, this study investigated the perceptions and experiences of HIV-positive persons, or those perceived to be at risk for HIV, as they sought health care services in locations around Kathmandu Valley. Results Health professionals were perceived to lack knowledge and sensitivity in providing health care to often marginalized and stigmatized injecting drug users, sex workers and HIV-positive people. Stigma and marginalization seem to interfere with doctors' and other health professionals' decisions to voluntarily treat persons who they perceive to be at high risk for HIV infections. Doctors and other health professionals appear suspicious, even unaware, of contemporary biomedical knowledge as it relates to HIV. The fear that certain marginalized groups, such as injecting drug users and sex workers, would be infected with HIV has further intensified stigma against these groups. Conclusion The study identified the beginning of a change in the experiences of HIV-positive people, or those at risk of HIV, in their seeking of health care. With focused, contemporary HIV education and training, the beginning of positive changes in the knowledge base and attitude of health providers seemed to be apparent to some participants of this study.
Health care workers' knowledge on HIV and aids: universal precautions and attitude towards PLWHA in Benin-City, Nigeria
AO Aisien, MO Shobowale
Nigerian Journal of Clinical Practice , 2005,
Abstract: Objective: Health care workers are at risk of becoming infected with blood-borne pathogens, including HIV. The study was designed to test health care workers knowledge about HIV transmission, universal precautions and their attitude towards people living with HIV and AIDS. Design: A cross-sectional study. Setting: University of Benin Teaching Hospital, Benin-City, Nigeria. Participants: 120 Health Care Workers (HCWs) who were occupationally exposed to patient's blood and body fluids completed a self administered structured questionnaire between March and May 2004. The HCWs consisted of 50 doctors drawn from obstetrics and gynaecology (25) and surgery departments (25). 70 nurses from accident and emergency unit (23), labour ward (18), labour ward theatre (4), main surgical theatre (22) and family planning clinic (3). Results: The mean age of the health care workers and duration of practice were 39.8 ± 8.0years and 14.0 ± 8.2years respectively. Though many of the respondents demonstrated good knowledge about HIV transmission, more than 25% of them thought that HIV could be transmitted through saliva, vomit, faeces and urine. They over estimated their risk of acquiring HIV infection following needle stick injury, exposure of mucocutaneous membrane and intact skin to infected blood and body fluids. There was poor adherence to universal precautions which was attributed to lack of knowledge and availability of materials in 48% and 60% of the workers respectively. Over 40% of the health care workers exhibited discriminatory attitude towards people living with HIV and AIDS. There was no statistical significant difference (p>0.05) in the knowledge of HIV and AIDS transmission and infection prevention practices amongst the doctors and nurses. Similarly there was no significant difference in their discriminatory attitude towards PLWHA. Conclusion: We recommend that seminars, workshops should be organized on a continuous basis for health care workers on universal precautions, stigma and discrimination reduction. Those trained should train others on the job. The institution should also make available materials needed to protect workers against the risk of acquiring pathogenic infection in the course of providing health services to their patients.
Validation of an HIV-related stigma scale among health care providers in a resource-poor Ethiopian setting
Feyissa GT, Abebe L, Girma E, Woldie M
Journal of Multidisciplinary Healthcare , 2012, DOI: http://dx.doi.org/10.2147/JMDH.S29789
Abstract: lidation of an HIV-related stigma scale among health care providers in a resource-poor Ethiopian setting Original Research (2083) Total Article Views Authors: Feyissa GT, Abebe L, Girma E, Woldie M Published Date March 2012 Volume 2012:5 Pages 97 - 113 DOI: http://dx.doi.org/10.2147/JMDH.S29789 Received: 08 January 2012 Accepted: 14 February 2012 Published: 28 March 2012 Garumma Tolu Feyissa1, Lakew Abebe1, Eshetu Girma1, Mirkuzie Woldie2 1Department of Health Education and Behavioral Sciences, 2Department of Health Services Management, Jimma University, Jimma, Ethiopia Background: Stigma and discrimination (SAD) against people living with human immunodeficiency virus (HIV) are barriers affecting effective responses to HIV. Understanding the causes and extent of SAD requires the use of a psychometrically reliable and valid scale. The objective of this study was to validate an HIV-related stigma scale among health care providers in a resource-poor setting. Methods: A cross-sectional validation study was conducted in 18 health care institutions in southwest Ethiopia, from March 14, 2011 to April 14, 2011. A total of 255 health care providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support (PIS) and HIV-related SAD. Exploratory factor analysis (EFA) with principal component extraction and varimax with Kaiser normalization rotation were employed to develop scales for SAD. Eigenvalues greater than 1 were used as a criterion of extraction. Items with item-factor loadings less than 0.4 and items loading onto more than one factor were dropped. The convergent validity of the scales was tested by assessing the association with HIV knowledge, PIS, training on topics related to SAD, educational status, HIV case load, presence of an antiretroviral therapy (ART) service in the health care facility, and perceived religiosity. Results: Seven factors emerged from the four dimensions of SAD during the EFA. The factor loadings of the items ranged from 0.58 to 0.93. Cronbach's alphas of the scales ranged from 0.80 to 0.95. An in-depth knowledge of HIV, perceptions of institutional support, attendance of training on topics related to SAD, degree or higher education levels, high HIV case loads, the availability of ART in the health care facility and claiming oneself as nonreligious were all negatively associated with SAD as measured by the seven newly identified latent factors. Conclusion: The findings in this study demonstrate that the HIV-related stigma scale is valid and reliable when used in resource-poor settings. Considering the local situation, health care managers and researchers may use this scale to measure and characterize HIV-related SAD among health care providers. Tailoring for local regions may require further development of the tool.
HIV/AIDS - Related Stigma and Discrimination in Nigeria: Review of Research Studies and future directions for Prevention Strategies
E Monjok, A Smesny, EJ Essien
African Journal of Reproductive Health , 2009,
Abstract: Human Immunodeficiency Virus (HIV) infection and AIDS remain a major public health crisis in Nigeria which harbors more people living with HIV than any other country in the world, except South Africa and India. A significant challenge to the success of achieving universal access to HIV prevention, treatment, care and support by 2010 is HIV-AIDS stigma and discrimination. Eight studies looking at some degree of measurement of stigma and discrimination in Nigeria were reviewed in an attempt to investigate the cultural context of stigma, health seeking behavior and the role both perceived and community stigma play in HIV prevention. Results suggest that reducing stigma does increase the individual as well as community acceptance of people living with HIV-AIDS (PLWHAs), but long term studies are needed. Some suggestions are recommended for future research on culture specific stigma studies in Nigeria (Afr J Reprod Health 2009; 13[3]:21-35).
Impact of court rulings on health care coverage: the case of HIV/AIDS in Colombia
González,Ana Cristina; Durán,Juanita;
MEDICC Review , 2011, DOI: 10.1590/S1555-79602011000300013
Abstract: this article addresses an emerging issue in health care systems: the impact of judicial rulings on public policy regarding financing and delivery of health care services, and the attendant tensions, contradictions and questions. in colombia, hiv/aids patients' use of a legal instrument called tutela, or writ of protection, has produced abundant jurisprudence and prompted health authorities to respond with decisions about hiv/aids service coverage that do not consider epidemiologic criteria and sustainability, introducing distortions in the health care system with respect to financing, priority-setting and universality.
Impact of court rulings on health care coverage: the case of HIV/AIDS in Colombia  [cached]
Ana Cristina González,Juanita Durán
MEDICC Review , 2011,
Abstract: This article addresses an emerging issue in health care systems: the impact of judicial rulings on public policy regarding financing and delivery of health care services, and the attendant tensions, contradictions and questions. In Colombia, HIV/AIDS patients' use of a legal instrument called tutela, or writ of protection, has produced abundant jurisprudence and prompted health authorities to respond with decisions about HIV/AIDS service coverage that do not consider epidemiologic criteria and sustainability, introducing distortions in the health care system with respect to financing, priority-setting and universality.
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