Nigeria: New Study Reveals Discrimination by Health Professionals Against People Living with HIV/AIDS is Fueled by Fear of Infection, Lack of Protecti
(Toronto) While the majority of Nigerian health care professionals comply with ethical obligations and do not deny care or treatment to People Living With AIDS (PLWA), a disturbing number of health care professionals engage in discriminatory behavior toward treatment and care of PLWA, according to a new study released today by Physicians for Human Rights (PHR). Health care professionals also reported engaging in practices that are against international and Nigerian codes of professional ethics including testing without consent and disclosure of confidential medical information without permission.
"The health sector is not immune to the kind of virulent discrimination that has hurt people with HIV/AIDS for many years. It is a very serious impediment to adequate AIDS treatment and affects the willingness of people with HIV to come forward," said Leonard Rubenstein, JD, PHR's Executive Director. "The study suggests that for some health providers at least, the lack of knowledge and lack of protective gear contributes to discrimination. Their fear affects their treatment of patients," said Rubenstein. "The situation underscores the need for a plan to build African health systems so that medical workers have information, gloves and other supplies to protect themselves while caring for patients."
The PHR report, Nigeria: Access to Health Care for People Living With AIDS, contains data from two surveys. The first is a survey of a representative sample of 1,021 health professionals in four sites in Nigeria, and the second, a convenience sample of people living with HIV/AIDS in those four states and in Lagos and Abuja. These findings were supplemented by a survey of directors within the facilities where the health professional surveys were conducted and individual interviews with key informants including national and state policymakers, NGO representatives, and officers of international agencies.
Ten percent of respondents themselves reported refusing to care for or admit people living with AIDS to a hospital. Sixty-six percent of respondents reported observing their colleagues' refusal to care for HIV/AIDS patients and 43% observed their colleagues' refusal to admit people living with AIDS to a hospital. Forty-eight percent of professionals expressed their belief that a person with HIV/AIDS cannot be treated effectively in their facility. Twelve percent of professionals said that treatment of opportunistic infections in HIV/AIDS patients wastes resources. Seven percent agreed that treating someone with HIV/AIDS is a waste of precious resources.
Among health care professionals, the three most important concerns about treating HIV/AIDS patients were fear of becoming infected (a full 81% of respondents expressed this), contamination of facility, materials and instruments (17%), and not having materials needed to treat (10%) the disease.
The study, which also included a survey of 227 people living with HIV/AIDS (PLWA), concludes that discrimination undermines efforts to provide effectiv e prevention, diagnosis and treatment programs.
"Discrimination can threaten the survival of people with HIV/AIDS by denying them medical care. It robs them of the fundamental respect for their dignity and their right to health," commented Rubenstein.
Seventy-two percent of health care professionals surveyed said they practice universal precautions in all cases. Of those who did not do so in all cases, 65% indicated that this was due to lack of materials. One policymaker quoted in the study stated, "Most hospitals don't have protective supplies. There is no incentive for health care professionals to risk infection."
A majority of health care providers surveyed have not received sufficient training on HIV and AIDS prevention and treatment and have limited access to current information about HIV and AIDS.
A large majority of professionals voiced support for protection of the rights of women and people with HIV/AIDS. Yet over half of the professionals reported that they obtained informed consent of patients for 50% or less of HIV tests they ordered, including 14% who indicated that they never obtained informed consent for HIV tests. Seventy-five percent of health care professionals agreed that there are circumstances where it is appropriate to test a patient for HIV without his or her knowledge or consent.
Most respondents to the PLWA survey reported being informed of their HIV status in the past three years. Approximately half of them (49%) stated that they did not know they were being tested for HIV. Eighteen percent of PLWA reported that it was their idea to be tested while 45% stated that the test was the idea of the health worker. About a quarter (24%) of respondents to the PLWA survey indicated that their current sexual partners were not aware of their HIV status. Five percent stated that their doctor revealed their HIV status to someone without their permission. Four percent said a nurse revealed their status without their permission and 3% reported that a laboratory technician did this. Seven percent reported being shunned by their family and 7% by their community.
The health care professional study was conducted in four Nigerian states: Abia, Gombe, Kano and Oyo. Survey respondents from each state, who were proportionally sampled, included doctors, nurses and midwives. Similarly, the people living with AIDS were interviewed in the four states and in Abuja and Lagos. This study represents the attitudes and experiences of nearly 4,500 health care professionals in the four states who serve a combined population of approximately 17.8 million people.
"Stigma associated with HIV/AIDS and the discriminatory behavior practiced by health providers has had an enormous impact on those people living with AIDS. Such practices are corrosive to the health sector in general, eroding trust in health practitioners and dissuading people infected with HIV/AIDS from seeking care and ultimately contributing to the spread of AIDS," said Rubenstein. An estimated 3.5 million Nigerians are living with HIV/AIDS.
Discrimination that occurs within the health sector may have devastating social and personal consequences and legitimize other forms of discrimination toward PLWA such as in the work place and by families and communities. PLWA may be evicted from their homes, be denied inheritance rights, lose their jobs or be passed over for promotion, or shunned by their families and communities. Anti-discrimination policies must be instituted and enforced by the government of Nigeria usch that those experiencing such behavior can seek redress, PHR said.
Respondents from both surveys - health professionals and people living with AIDS -- identified a lack of financial resources as being the greatest barrier that HIV positive people face when trying to access health care.
Recommendations
President Olusegun Obasanjo's signature of the Government's new HIV/AIDS policy and stated government commitment to pass legislation protecting PLWA from discrimination are promising steps. In moving forward to implement the new National HIV/AIDS Policy, the relevant stakeholders should include the following steps:
Government of Nigeria:
"The health sector is not immune to the kind of virulent discrimination that has hurt people with HIV/AIDS for many years. It is a very serious impediment to adequate AIDS treatment and affects the willingness of people with HIV to come forward," said Leonard Rubenstein, JD, PHR's Executive Director. "The study suggests that for some health providers at least, the lack of knowledge and lack of protective gear contributes to discrimination. Their fear affects their treatment of patients," said Rubenstein. "The situation underscores the need for a plan to build African health systems so that medical workers have information, gloves and other supplies to protect themselves while caring for patients."
The PHR report, Nigeria: Access to Health Care for People Living With AIDS, contains data from two surveys. The first is a survey of a representative sample of 1,021 health professionals in four sites in Nigeria, and the second, a convenience sample of people living with HIV/AIDS in those four states and in Lagos and Abuja. These findings were supplemented by a survey of directors within the facilities where the health professional surveys were conducted and individual interviews with key informants including national and state policymakers, NGO representatives, and officers of international agencies.
Ten percent of respondents themselves reported refusing to care for or admit people living with AIDS to a hospital. Sixty-six percent of respondents reported observing their colleagues' refusal to care for HIV/AIDS patients and 43% observed their colleagues' refusal to admit people living with AIDS to a hospital. Forty-eight percent of professionals expressed their belief that a person with HIV/AIDS cannot be treated effectively in their facility. Twelve percent of professionals said that treatment of opportunistic infections in HIV/AIDS patients wastes resources. Seven percent agreed that treating someone with HIV/AIDS is a waste of precious resources.
Among health care professionals, the three most important concerns about treating HIV/AIDS patients were fear of becoming infected (a full 81% of respondents expressed this), contamination of facility, materials and instruments (17%), and not having materials needed to treat (10%) the disease.
The study, which also included a survey of 227 people living with HIV/AIDS (PLWA), concludes that discrimination undermines efforts to provide effectiv e prevention, diagnosis and treatment programs.
"Discrimination can threaten the survival of people with HIV/AIDS by denying them medical care. It robs them of the fundamental respect for their dignity and their right to health," commented Rubenstein.
Seventy-two percent of health care professionals surveyed said they practice universal precautions in all cases. Of those who did not do so in all cases, 65% indicated that this was due to lack of materials. One policymaker quoted in the study stated, "Most hospitals don't have protective supplies. There is no incentive for health care professionals to risk infection."
A majority of health care providers surveyed have not received sufficient training on HIV and AIDS prevention and treatment and have limited access to current information about HIV and AIDS.
A large majority of professionals voiced support for protection of the rights of women and people with HIV/AIDS. Yet over half of the professionals reported that they obtained informed consent of patients for 50% or less of HIV tests they ordered, including 14% who indicated that they never obtained informed consent for HIV tests. Seventy-five percent of health care professionals agreed that there are circumstances where it is appropriate to test a patient for HIV without his or her knowledge or consent.
Most respondents to the PLWA survey reported being informed of their HIV status in the past three years. Approximately half of them (49%) stated that they did not know they were being tested for HIV. Eighteen percent of PLWA reported that it was their idea to be tested while 45% stated that the test was the idea of the health worker. About a quarter (24%) of respondents to the PLWA survey indicated that their current sexual partners were not aware of their HIV status. Five percent stated that their doctor revealed their HIV status to someone without their permission. Four percent said a nurse revealed their status without their permission and 3% reported that a laboratory technician did this. Seven percent reported being shunned by their family and 7% by their community.
The health care professional study was conducted in four Nigerian states: Abia, Gombe, Kano and Oyo. Survey respondents from each state, who were proportionally sampled, included doctors, nurses and midwives. Similarly, the people living with AIDS were interviewed in the four states and in Abuja and Lagos. This study represents the attitudes and experiences of nearly 4,500 health care professionals in the four states who serve a combined population of approximately 17.8 million people.
"Stigma associated with HIV/AIDS and the discriminatory behavior practiced by health providers has had an enormous impact on those people living with AIDS. Such practices are corrosive to the health sector in general, eroding trust in health practitioners and dissuading people infected with HIV/AIDS from seeking care and ultimately contributing to the spread of AIDS," said Rubenstein. An estimated 3.5 million Nigerians are living with HIV/AIDS.
Discrimination that occurs within the health sector may have devastating social and personal consequences and legitimize other forms of discrimination toward PLWA such as in the work place and by families and communities. PLWA may be evicted from their homes, be denied inheritance rights, lose their jobs or be passed over for promotion, or shunned by their families and communities. Anti-discrimination policies must be instituted and enforced by the government of Nigeria usch that those experiencing such behavior can seek redress, PHR said.
Respondents from both surveys - health professionals and people living with AIDS -- identified a lack of financial resources as being the greatest barrier that HIV positive people face when trying to access health care.
Recommendations
President Olusegun Obasanjo's signature of the Government's new HIV/AIDS policy and stated government commitment to pass legislation protecting PLWA from discrimination are promising steps. In moving forward to implement the new National HIV/AIDS Policy, the relevant stakeholders should include the following steps:
Government of Nigeria:
- Provide sufficient supplies of protective materials for practice of universal precautions including the provision of gloves and disposable syringes to all health facilities under Federal Ministry of Health control.
- Provide sufficient supplies of drugs including antiretrovirals (ARVs) (for post-exposure prophylaxis and treatment), antibiotics and other drugs needed for treatment and prevention of HIV/AIDS and related conditions to all health facilities; make these drugs available to patients at a reasonable cost.
- Develop and implement programs to educate health care professionals and all staff in health facilities about HIV/AIDS including modes of transmission and universal precautions, ethics, and treatment and care. Involve PLWA in preparation of these programs.
- Engage in a thorough review of laws and the constitution and enact reform to ensure legal protection of PLWA in all sectors.
- Uphold standards of medical practice that are consistent with Nigerian codes of medical ethics. Engage in continuing education of physicians, nurses and midwives on HIV/AIDS and on matters of professional ethics.
- Work with the Nigerian Federal and State Ministries of Health, Local Government Authorities and health care professionals to develop, promulgate and enforce HIV/AIDS testing and treatment policies within health institutions that conform to the Nigerian code medical ethics and that guarantee non-discrimination against PLWA.
- Uphold standards of medical practice that are consistent with Nigerian codes of medical ethics. Engage in continuing education of physicians, nurses and midwives on HIV/AIDS and on matters of professional ethics.
- Provide material and technical assistance, in particular to professional associations for efforts to educate health professionals and the public about HIV/AIDS and ethics of the medical profession.
- Provide material and logistical support to ensure that all health facilities have sufficient and consistent supplies of materials for HIV/AIDS treatment and prevention, including for implementation of universal precautions.
- Support the Global Fund to Fight AIDS, Tuberculosis and Malaria.
posted by AIDS-Care-Watch at 3:31 pm
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