Front-line health workers - crucial to tackling TB and HIV related stigma and discrimination
by Andy Seale, Advocacy Adviser UNAIDS
The role of health care workers throughout the world is crucial to an effective AIDS response for a number of reasons. Health care workers not only contribute in the obvious way through staffing essential health services that directly save and prolong lives but they are also critical in challenging the stigma and discrimination that still violently threatens an effective response to AIDS.
The impact of stigma and discrimination has long been documented - ignorance and fear around HIV and AIDS can lead to communities stigmatizing those most associated with the epidemic. Stigma and discrimination combine to create an environment where people are less likely to confront HIV. As we know, inaction whether it is from governments or individuals - can be fatal.
Stigma and discrimination present a complex challenge because we know that when there is a greater uptake of HIV and AIDS services’ communities often start to break down the cycle of fear, denial, stigma and discrimination. This helps to create the kind of environment where stigma is less likely to take hold in the first place. It is therefore absolutely crucial that the health care environment is free of stigma and discrimination – placing considerable responsibility on the shoulders of health care workers.
Sadly, and despite the awe-inspiring work of many health care workers around the world, surveys from a wide range of countries have shown a significant number of health care workers admitting to having refused to care for an AIDS patient, or had denied HIV positive patients admission to a hospital. People all over the world have experienced discrimination at the hands of health care workers with many denied medicine because of their HIV status - yet ironically we know that greater access to care and treatment is a key factor to undermining stigma.
Health care workers play a crucial role at every level in ensuring that services are stigma-free and non-discriminating. And when they interact within their communities outside of work they are also in a strong position to enlighten others about the realities of HIV and AIDS and challenge stigma.
Who is better placed to talk candidly about the challenges and realities of people living with HIV and AIDS outside the infected and affected communities themselves? Surely it must be the people who work most directly with people living with HIV and AIDS? The role of health care workers must not be underestimated.
Increasing access to treatment is one of the most powerful incentives for individuals to discover their HIV status and the prospect of a longer more productive life for individuals encourages communities to reassess the way they relate to people living with HIV, creating a sense of hope and reducing the feelings of threat and burden which can trigger stigma in the first place.
Other powerful efforts to curb HIV-and AIDS-related stigma and discrimination are driven by the involvement of people living with, or affected by, HIV or AIDS. Where health care workers nurture close relationships with their clients there is always less stigma -both in the health care setting itself and often in wider communities. HIV and AIDS-related stigma and discrimination often builds on pre-existing social inequalities, prejudices and patterns of exclusion, and further marginalizes people who are already most vulnerable to HIV. These groups, depending on the national context, can include women and girls, men who have sex with men, sex workers and their clients, injection drug users and sexually active young people. It is essential that health care workers are supported to interact effectively with marginalized groups and to reflect on how they can work with them to combat stigma and discrimination.
The stigma around death and AIDS remains high in many contexts and is one area familiar to those also working in TB. Families often prefer to record the death of a loved one as TB-related rather than AIDS-related as they perceive there is less taboo around dying of TB compared to AIDS. When we look at the reasons for this stigma we can see it is usually driven by ill-informed concepts of “innocence” and “guilt” around modes of transmission. We can then understand why TB can be more “acceptable” to some people. Health care workers are uniquely placed to be able to remind people that these are both 'diseases' that require a dignified and professional response.
Much can be done to improve health systems and country-level capacity to deal with both AIDS and TB but as we all rally and advocate for improved health infrastructures and scaling up of interventions - let us not lose sight of the crucial role health care workers also play in fighting stigma and discrimination.
We all need to do more to acknowledge and support this vital role. But this is not easy. The negative consequences are all too obvious when stigma and discrimination occur in health settings but it is hard to measure how health care workers contribute to positively changing attitudes and challenging stigma. Yet it is not impossible. We all owe it to health care workers around the world to think creatively of how we can best capture and document the positive impact they have on influencing attitudes and challenging stigma and discrimination. Their work in this field is truly invaluable.
(March 2005)
Source: Stop TB eForum
The role of health care workers throughout the world is crucial to an effective AIDS response for a number of reasons. Health care workers not only contribute in the obvious way through staffing essential health services that directly save and prolong lives but they are also critical in challenging the stigma and discrimination that still violently threatens an effective response to AIDS.
The impact of stigma and discrimination has long been documented - ignorance and fear around HIV and AIDS can lead to communities stigmatizing those most associated with the epidemic. Stigma and discrimination combine to create an environment where people are less likely to confront HIV. As we know, inaction whether it is from governments or individuals - can be fatal.
Stigma and discrimination present a complex challenge because we know that when there is a greater uptake of HIV and AIDS services’ communities often start to break down the cycle of fear, denial, stigma and discrimination. This helps to create the kind of environment where stigma is less likely to take hold in the first place. It is therefore absolutely crucial that the health care environment is free of stigma and discrimination – placing considerable responsibility on the shoulders of health care workers.
Sadly, and despite the awe-inspiring work of many health care workers around the world, surveys from a wide range of countries have shown a significant number of health care workers admitting to having refused to care for an AIDS patient, or had denied HIV positive patients admission to a hospital. People all over the world have experienced discrimination at the hands of health care workers with many denied medicine because of their HIV status - yet ironically we know that greater access to care and treatment is a key factor to undermining stigma.
Health care workers play a crucial role at every level in ensuring that services are stigma-free and non-discriminating. And when they interact within their communities outside of work they are also in a strong position to enlighten others about the realities of HIV and AIDS and challenge stigma.
Who is better placed to talk candidly about the challenges and realities of people living with HIV and AIDS outside the infected and affected communities themselves? Surely it must be the people who work most directly with people living with HIV and AIDS? The role of health care workers must not be underestimated.
Increasing access to treatment is one of the most powerful incentives for individuals to discover their HIV status and the prospect of a longer more productive life for individuals encourages communities to reassess the way they relate to people living with HIV, creating a sense of hope and reducing the feelings of threat and burden which can trigger stigma in the first place.
Other powerful efforts to curb HIV-and AIDS-related stigma and discrimination are driven by the involvement of people living with, or affected by, HIV or AIDS. Where health care workers nurture close relationships with their clients there is always less stigma -both in the health care setting itself and often in wider communities. HIV and AIDS-related stigma and discrimination often builds on pre-existing social inequalities, prejudices and patterns of exclusion, and further marginalizes people who are already most vulnerable to HIV. These groups, depending on the national context, can include women and girls, men who have sex with men, sex workers and their clients, injection drug users and sexually active young people. It is essential that health care workers are supported to interact effectively with marginalized groups and to reflect on how they can work with them to combat stigma and discrimination.
The stigma around death and AIDS remains high in many contexts and is one area familiar to those also working in TB. Families often prefer to record the death of a loved one as TB-related rather than AIDS-related as they perceive there is less taboo around dying of TB compared to AIDS. When we look at the reasons for this stigma we can see it is usually driven by ill-informed concepts of “innocence” and “guilt” around modes of transmission. We can then understand why TB can be more “acceptable” to some people. Health care workers are uniquely placed to be able to remind people that these are both 'diseases' that require a dignified and professional response.
Much can be done to improve health systems and country-level capacity to deal with both AIDS and TB but as we all rally and advocate for improved health infrastructures and scaling up of interventions - let us not lose sight of the crucial role health care workers also play in fighting stigma and discrimination.
We all need to do more to acknowledge and support this vital role. But this is not easy. The negative consequences are all too obvious when stigma and discrimination occur in health settings but it is hard to measure how health care workers contribute to positively changing attitudes and challenging stigma. Yet it is not impossible. We all owe it to health care workers around the world to think creatively of how we can best capture and document the positive impact they have on influencing attitudes and challenging stigma and discrimination. Their work in this field is truly invaluable.
(March 2005)
Source: Stop TB eForum
posted by AIDS-Care-Watch at 4:12 am
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