Апстракт
Background: Stigma and discrimination pose major obstacles to accessing care and support by People Living With HIV/AIDS (PLWHA). Information on HIV stigma and discrimination towards PLWHA among Nigerian health workers has mainly been at higher levels of care. This paper examined HIV stigma and discrimination at the primary health care level with the objective of identifying its occurrence and determinants among health workers at this level.
Methods: A total sample of all health care workers (341) at the primary health care level in Ilorin, Kwara State were surveyed via questionnaire between July and August 2007 to obtain information on their sociodemographic characteristics and the four domains of stigma viz: fear of casual transmission of HIV, shame and blame, discrimination and disclosure.
Results: Majority of the respondents had fear of casual transmission of HIV (87.7%), exhibited shame and blame (89.4%), reported observing discrimination against PLWHA by other health workers in their facilities (97.7%) and believed that disclosure of patients HIV status to health workers was imperative. Nurses/midwives were more likely to have fear of casual transmission of HIV and believe that disclosure of HIV status of patients was imperative. Respondents who had received in service training were less likely to exhibit shame and blame (p <0.05).
Conclusion: Stigma occurred in all stigma domains among this group of health workers but previous training was found to play a role in the reduction of shame and blame. Training of health care workers within the context of the various stigma domains is advocated.
Keywords: Stigma, discrimination, health care workers, primary health care level, in- service training, stigma domains
Résumé
Introduction: La stigmatisation et la discrimination liée au VIH posent des obstacles importants au soin d’accès et au support aux personnes vivant avec le VIH/SIDA (PLWHA). L’information sur le stigmate et la discrimination des PLWHA parmi les professionnels de la santé nigérianne a principalement été à des niveaux plus élevés de soins. Cette étude a examiné la stigmatisation et la discrimination liées au VIH au niveau des soins de santé primaires dans le but d’identifier son apparition et déterminants chez les travailleurs de la santé à ce niveau.
Méthodologie: Un échantillon de l’ensemble du personnel en santé (341) au niveau des soins de santé primaires à Ilorin, Kwara, Nigeria ont été interrogés par questionnaire structuré entre Juillet - Août 2007 pour obtenir des informations sur leurs caractéristiques sociodémographiques et les quatre domaines de la stigmatisation à savoir: la peur de la transmission occasionnelle du VIH, la honte et le blâme, la discrimination et la communication.
Résultats:La majorité des sujets ont eu peur de la transmission occasionnel du VIH (87,7%), a présenté la honte et le blâme (89,4%), a rapporté l’observation de la discrimination contre les personnes vivant avec VIH par d’autre personnel de santé dans leurs installations (97,7%) et croit que la divulgation de la séropositivité des patients aux agents de santé était impératif. Les infirmières / sages-femmes étaient plus susceptibles d’avoir peur de la transmission du VIH et décontractées que la divulgation du statut sérologique des patients était impérative. Les sujets qui avaient reçu une formation continue étaient moins susceptibles d’exposer la honte et le blâme (p  0,05).
Conclusion: La stigmatisation a eu lieu dans tous les domaines de la stigmatisation au sein de ce groupe du personnel de santé, mais la formation antérieure a prouvé de jouer un rôle dans la réduction de la honte et le blâme. La formation du personnel de santé dans le cadre des différents domaines de la stigmatisation est préconisée.
Correspondence: O.O. Sekoni, Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: t1toyin@yahoo.com
Референце
UNAIDS Global AIDS epidemic facts and figures. Global fact sheet. Joint United Nations Programme on HIV/AIDS. Accessed 24 December 2012: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_FactSheet_Global_en.pdf 2012.
FMOH. 2001 National HIV Sentinel Seroprevalence Surveillance Report. National AID/HIV/STD Control Programme. Federal Ministry of Health Abuja, Nigeria. 2002.
FMOH. 2005 National HIV Sentinel Seroprevalence Surveillance Report. National AID/HIV/STD Control Programme. Federal Ministry of Health and Social Services. Nigeria. 2006.
FMOH. National HIV/AIDS and Reproductive Health Survey. 2007 (NARHS Plus) Federal Ministry of Health and Social Services. Nigeria 2008.
Link BG, Phelan JC. Labeling and stigma. In the Handbook of the Sociology of Mental Health, ed. CS Aneshensel, JC Phelan. 1999; New York: Plenum.
UNAIDS. UNAIDS Fact Sheet on Stigma and Discrimination. December 2003.
Sayles JN, Wong MD, Kinsler JJ, et al. The Association of Stigma with Self - Reported Access to Medical Care and Antiretroviral Therapy Adherence in Persons Living with HIV/AIDS. J Gen Intern Med. 2009; 24(10): 1101-1108.
Goudge J, Ngoma B, Manderson L and Schneider H. Stigma, identity and resistance among people living with HIV in South Africa. SAHARA J. 2009;6(3): 94-104.
Feyissa GT, Abebe L, Girma E et al. Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health 2012; 12:522. Accessed 15 November 2012: http://www.biomedcentral.com/1471-2458/12/522.
Mahendra VS, Gilborn L, Bharat S, et al. Understanding and measuring AIDS-related stigma in health care settings: a developing country perspective. SAHARA J, 2007; 4(2):616-625
Aisien AO and Shobowale M. O. Health care workers’ knowledge on HIV and AIDS: universal precautions and attitude towards PLWHA in Benin-City, Nigeria. Niger J Clin Pract. 2005; 8(2): 74-82.
Webber GC. Chinese health care providers’ attitudes about HIV: a review. AIDS Care. 2007; 19: 685-691.
Adebajo SB, Bamgbala AO and Oyediran MA. Attitudes of Health Care Providers to Persons Living with HIV/AIDS in Lagos State, Nigeria. Afr J Reprod Health.2003; 7(1): 103-112.
NACA. National Policy on HIV/AIDS. 2002 National Agency for the Control of AIDS. Abuja. 2003.
Adeokun L, Okonkwo P and Ladipo OA. (Eds.). The stigmatization of people living with HIV/AIDS. Cambridge, Massachusetts: Harvard Center for Population and Development Studies. 2006.
Reis C, Heisler M., Amowitz LL, et al,. Discriminatory Attitudes and Practices by Health Workers toward Patients with HIV/AIDS in Nigeria. Public Library of Science Medicine. 2005; 2(8) Accessed 15 February 2012: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0020246
Kish L. Survey Sampling. New York: John Wiley and Sons.1994.
POLICY Project, ICRW, Horizons, MEASURE/Evaluation. 2004. HIV/AIDS-related Stigma and Discrimination Indicators Development Workshop Report.
USAID/HPI. Stigmatization and discrimination of HIV- positive people by providers of general medical services in Ukraine.: Constella Futures, Center for Development and Population Activities(CEDPA), White Ribbon Alliance for Safemotherhood (WRA) and World Conference of Religions for Peace (WCRP). 2007.
Bishop GD, Oh HML and Swee HY. Attitudes and Beliefs of Singapore Health Care Professionals Concerning HIV/AIDS. Singapore Med J., 2000; 41(2): 55-63.
Nyblade L, Pande R, Mathur S., et al. Disentangling HIV and AIDS stigma in Ethiopia, Tanzania and Zambia. ICRW. Washington D.C., 2003;12(1):15.
CDC. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis. Journal 2005; 54(RR09): 1-17. Accessed 19 January 2012: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm.
Faris R and Shouman A. Study of the knowledge, attitude of Egyptian health care workers towards occupational HIV infection. J Egypt Public Health Assoc. 1994;69(1-2): 115-128.
Jean Baptiste R. HIV/AIDS- related Stigma, Fear and Discriminatory Practices among Healthcare Providers in Rwanda. Operations Research Results. Bethesda, MD: Quality Assurance Project. University Research Co., LLC. 2008.
Nyblade L, MacQuarrie K, Philip F et al., Measuring HIV stigma: results of a field test in Tanzania.2005
Wu S, Li L, Wu Z et al., A brief HIV stigma reduction intervention for service providers in China. AIDS Patient Care and STDS, 2008; 22(6): 513-520.
Li L, Wu Z, Wu S, et al,. Mandatory HIV testing in China: the perception of health-care providers. International Journal of STD & AIDS. 2007; 18: 476-481.
Oyeyemi AY, Oyeyemi BO and Bello IS. Physicians and AIDS care: does knowledge influence their attitude and comfort in rendering care? Afr J Health Sci. 2007; 14(1/2): 37-43.
Duyan V, Agalar F and Sayek I. Surgeons’ attitudes towards HIV/AIDS in Turkey. AIDS CARE, 2001; 13(2): 243-250.
Adebamowo CA, Ezeome ER, Ajuwon JA and Ogundiran TO. Survey of the knowledge, attitude and practice of Nigerian surgery trainees to HIV -infected persons and AIDS patients. BMC Surgery 2002; 2: 7. Accessed 21 March 2012: http://www.biomedcentral.com/1471-2482/2/7
Valle M and Levy J. Weighing the Consequences: Self-Disclosure of HIV-Positive Status Among African American Injection Drug Users Health Educ Behav. 2009; 36: 1.
Szabo CP, Dhai A, Veller M and Kleinsmidt A. Surgeons and HIV: South African attitudes. S Afr Med J., 2009; 99(2): 110-113.
Andrewin A and Chien LY. Stigmatization of patients with HIV/AIDS among doctors and nurses in Belize. AIDS Patient Care and STD. 2008; 22(11): 897-906.