Health workers profess neutral or positive attitudes in surveys, yet patients report discrimination in health-care settings.
On World AIDS Day, demonstrators in Lima, Peru, called for access to antiretroviral treatment for HIV/AIDS patients. © Rosa Fernández/PAHO Peru
A recent report by the Pan American Health Organization (PAHO) reveals that patients with HIV or AIDS experience stigma and discrimination from doctors, nurses and other health care providers just as from members of society at large. Released on World AIDS Day, the PAHO report, Understanding and Responding to HIV/AIDS-Related Stigma and Discrimination in the Health Sector, reviews research on the attitudes and practices of health care providers and the experiences of HIV/AIDS patients. It finds that stigma and discrimination threaten the quality of patient care as well as efforts to control the epidemic’s spread in the Americas and other regions.
The negative consequences of stigma and discrimination include increasing HIV/AIDS patients' feelings of social isolation and depression and discouraging people from getting tested for HIV. This reduces their chances of getting the care they need and thus limits the scope and effectiveness of prevention efforts.
On a positive note, the report also finds that discrimination declines as knowledge about the disease increases and as new treatments diminish the notion of AIDS as a "death sentence."
According to research reviewed in the report, most health workers express neutral or positive attitudes toward HIV/AIDS patients, yet patients themselves report widespread experiences of discrimination in health care settings. These extend not only to people known to be HIV-positive but also to those perceived as belonging to stigmatized groups, such as drug users and homosexuals.
Discrimination in health care settings takes a variety of forms and can result in delayed, inappropriate or withheld treatment, breaches of confidentiality, inappropriate behavior, and use of excessive precautions. The report notes that it can even lead to a false sense of safety and make health workers fail to take proper precautions when dealing with patients who are not perceived as members of stigmatized groups.
The report also cites positive findings, including those of a 1994 U.S. survey showing significant improvement in health workers' attitudes compared with earlier years.
"There is also evidence of changing values, together with increased pragmatism, care and compassion," says the report. "Media images of the epidemic are now more positive and informative, and a gradual shift in the attitudes of health workers was noted." Moreover, "increased awareness of HIV/AIDS in society as a whole and increased familiarity with patients with the disease helps most health workers to feel more comfortable working with people with the virus."
In its conclusions, the report calls on PAHO's Member States to promote activities aimed at further reducing stigma and discrimination in the health sector. Among its recommendations are:
- Training projects to increase health workers' understanding of HIV/AIDS and to improve their practical and attitudinal skills.
- Appropriate procedures and supplies to enable health care workers to carry out their duties with minimum risk of occupational exposure.
- Establishment of patient and staff support groups.
- Institutional and sector-level programs HIV Patients Face Stigma in Health Sector based on adequate needs assessments and involving staff, patients and other affected groups, in partnership with governments and nongovernmental organizations.
- Promotion of voluntary counseling, testing and care (including post-exposure prophylaxis) for all health workers.
- Development of simple, effective systems that maintain confidentiality at all levels.
- Development and dissemination of policy, guidelines, training resources and other materials in appealing formats.
- Support for general and specialist professional associations in AIDS care.
The report also notes that "interventions in the health services are most successful when they are part of a broader campaign to reduce stigma and discrimination in the community as a whole." As an example of such intervention, the report cites favorably a national campaign launched by Brazil in 2002 to promote diversity and help reduce discrimination against homosexuals.
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