HEALTH CARE HIV and AIDS RELATED STIGMA AND DISCRIMINATION Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011) Ibekwe Alexander National Youth Council of Nigeria (NYCN) 4 Eket Close, off Emeka Anyaoku Street Area 11 Garki, Abuja, Nigeria ,

Outline IntroductionBackgroundMethodsResultRecommendationSummaryConclusion Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Introduction Medical and nursing care for PLHIV constitutes one aspect of HIV/AIDS comprehensive care and support intervention. The provision of this service largely depends on the existence of a well functioning health care system. An important issue related to the latter is making the services accessible to all those who need them without any form of discrimination. Because of stigma and discrimination, patients may be given substandard care, treated with disdain, face limited access to services, where by preventing them from receiving life saving health care. Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

What is Stigma? STIGMA: refers to unfavourable attitudes and beliefs directed toward someone or something. DISCRIMINATION: is the treatment of an individual or group with partiality or prejudice DISCRIMINATION: is the treatment of an individual or group with partiality or prejudice Stigmatization reflects an attitude Stigmatization reflects an attitude Discrimination is an act or behaviour Discrimination is an act or behaviour Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Forms of stigma (contd.) VERBAL STIGMA  Gossip, taunting, scolding  Labeling: in South East: “ Obilinajaocha," “it ends at the grave," and “ Mminwu." a drying sickness” INSTITUTIONALIZED STIGMA  Barred from jobs, scholarships, visas  Denial of health services Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Why is AIDS so highly stigmatized? Stigma is more intense when the condition is: 1) Perceived as lethal and incurable 2) Perceived to be the responsibility of the bearer Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Effects of Stigma in service delivery (Health Care)  Discourages access to ANC services  Prevents access to counselling, HIV testing and MTCT services  Discourages disclosure of HIV test results to partner(s)  Discourages acceptance of MTCT interventions  Inhibits use of safer infant-feeding practices  Confers secondary stigmatisation on the child  High rates of depression and suicide. Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Examining HIV/AIDS related stigma and discrimination in the Health care setting: Method: Twenty health facilities were selected in Anambra State Eastern Nigeria Four referral hospitals, eight well known and established private hospital and Lab. and eight health centers were included in the survey 430 technical, supportive health care workers and PLHIV were interviewed, and 50 sections were observed. Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Results When stigma scores were calculated, nearly two-thirds of all staff (64 percent) fell into the moderate stigma category. 24 percent were in the high stigma category. Only 12 percent were classified in the low category. low category Stigma scores were similar across the 20 participating Health Centers. Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Results Cont. Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Results Cont. 2/3 of respondents reported that any client suspected of being HIV positive will be tested without counseling and without his or her consent. If they are positive their result will be hand over to their family without the persons consent If they are positive their result will be hand over to their family without the persons consent 13% belief that HIV infected person and AIDS patients should be segregated from others Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Results Contd. The study identified that there is significant stigma and discrimination going on in the health facilities. Despite several efforts of community-based HIV/AIDS prevention programme, PLHIV still face several challenges in accessing health care and social services. It also showed that there is huge breach of confidentiality. Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Results Contd. PLHIV complained of lack of privacy & did not want to go to a particular Treatment Center. Many PLHIV said that they were not allow to choose how, when and to whom to disclose their HIV status. Some nurses said that in some instances, a patient's HIV status was shared with other patients in the same ward. Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Results Contd. Results Contd. There are different modalities of labeling clients with HIV and AIDS One of the Responses from nurse “Yes, we write HIV-positive with red ink on the case sheet [patient files], so that who ever picks up the case sheet can see the status of the patient, We put bed signs for HIV-positive patients. We write.High Risk Patients. I think everyone should know of HIV-positive patient's status” Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

So what can we do to reduce AIDS-related stigma? Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Stigma interventions Few interventions to date No rigorous evaluations conducted Research suggests possible directions, but setting-specific formative work needed to ensure that local issues are addressed. Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Addressing stigma Interventions addressing HIV-related stigma can take place at all levels: Interventions addressing HIV-related stigma can take place at all levels: National National Community Community Health facility Health facility Individual Individual Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Addressing stigma in Health Care setting  Educate and train healthcare providers in  HIV transmission  Activities to address stigma  Awareness of language that describes PLHIV  MTCT-related policies  Counselling and safer infant feeding practices Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Addressing stigma Enlist manager’s help to ensure policies and procedures are in place and implemented for: Non-discrimination policies Non-discrimination policies Confidentiality Confidentiality Universal precautions Universal precautions Post-exposure prophylaxis (PEP) Post-exposure prophylaxis (PEP) Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Summary  Stigmatisation reflects an attitude  Discrimination is an act or behaviour  Stigma and discrimination are often linked to violations of human rights  Human rights declarations affirm all peoples’ rights to be free from discrimination, including discrimination based on HIV/AIDS status. Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Summary contd.  HIV/AIDS-related stigmatisation and discrimination can discourage access to key HIV services, including:  Testing  MTCT services  Antenatal care  ARV prophylaxis Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Summary contd. Stigma discourages Stigma discourages  Disclosure of HIV status  Acceptance of safer infant-feeding practices  Access to education, counselling, and treatment even when such services are available and affordable Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Summary contd.  The MTCT programs and staff can help reduce stigma and discrimination in the healthcare setting and the community  Encourage MTCT staff to serve as role models  Involve PLHIV  Promote partner participation and community support Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Conclusion  Reducing stigma and discrimination is crucial to the success of Universal Access to HIV/AIDS treatment, prevention, care and support programmes.  HIV stigma and discrimination in the health setting is the major course of death amongst PLHIV, only when this issue be addressed, free flow, access and self disclosure will be achieved. Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Acknowledgement Network People Living with HIV/AIDS in Nigeria (NEPWHAN) Anambra State Agency for the Control of AIDS (ANSACA) Her Excellency, Mrs. Margaret Peter Obi (The wife of Anambra State Governor) Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Remember, Teamwork makes dreams work Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)

Pressented by Ibekwe Alexander 16th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2011)