DISCRIMINATION AND STIGMA IN HEALTHCARE SETTINGS: THE ITALIAN SITUATION Matteo Schwarz Legal Division NPS Italia Onlus

DISCRIMINATION AND STIGMA IN HEALTHCARE SETTINGS: THE ITALIAN SITUATION Like most countries in Europe and the western world, Italy has experienced a significant change in the evolution of the HIV epidemic in the last 15 years. Although the introduction of HAART in the second half of the nineties has gradually led to a decisive change of perspective in the treatment of HIV/AIDS and in the life expectancy of most patients, we cannot claim to have witnessed the growth of an equally conscious awareness in the civil society and in the institutions.

Current Situation in Italy Old prejudices still survive Old prejudices still survive –AIDS linked to certain behaviors – prejudices against key populations –Fuels quiet spread of HIV in all parts of society Consequences Consequences –Awareness of risk of HIV has diminshed –Number of infections is not declining anymore –Barriers to access and adherence continue

Italian Health Care Facilities Stigma and discrimination remain widespread in Health Care Facilities Stigma and discrimination remain widespread in Health Care Facilities NPS frequently responds to complaints and requests for help through website and phone NPS frequently responds to complaints and requests for help through website and phone Many episodes go unreported Many episodes go unreported Examples: Examples: –12 year old boy rejected from sports club –PLHIV denied access to dental care

Good legislation exists Good legislation exists Stigma and discrimination impedes people making complaints and following through with legal proceedings Stigma and discrimination impedes people making complaints and following through with legal proceedings Legal fees can be another barrier Legal fees can be another barrier Legal proceedings should be the last option for Health Care settings Legal proceedings should be the last option for Health Care settings Legal Protection in Italy

Reducing S & D in Health Care Settings Ongoing, comprehensive and evaluated training of health workers Ongoing, comprehensive and evaluated training of health workers –Understanding of transmission risk –Universal precautions –Expanding training beyond Infectious Diseases clinics/wards and to all non-clinical staff

Reducing S & D in Health Care Settings Management of sensitive data should be respectful of privacy and comply with legal requirements Management of sensitive data should be respectful of privacy and comply with legal requirements –Existing tools are not always sufficient  Numeric codes for disability can be easily decoded  Confidential informational collected in waiting room and by untrained staff

Reducing S & D in Health Care Settings Enforcement of professional codes of ethics Enforcement of professional codes of ethics –Professional associations frequently choose not to discipline members NPS Italia and other NGOs are implementing training to all health care workers NPS Italia and other NGOs are implementing training to all health care workers –Training includes universal precautions, management of health data, and attitudes towards PLHIV and other communicable diseases –1 day accredited training

HIV+ Health Care Workers Two sets of obstacles Two sets of obstacles –Relationships with colleagues and employers –Contact with patients Changes in Legislation expose Health Care Workers to breeches in confidentiality Changes in Legislation expose Health Care Workers to breeches in confidentiality –Allows employers to require HIV testing (Legge N.135/1990) –Example concerning Defence Ministry

Conclusions HIV testing as a requirement of employment continues due to misinterpretation of legislation HIV testing as a requirement of employment continues due to misinterpretation of legislation –Need for coherence in interpretation of law NPS collaboration with trade unions and public institutions NPS collaboration with trade unions and public institutions NPS planning to establish standards and credentials for non-discriminitory workplaces NPS planning to establish standards and credentials for non-discriminitory workplaces