Indian state to adopt workplace HIV policy - report

By, Reuters Foundation, November 19, 2006

MUMBAI - India's western state of Maharashtra is set to introduce a policy aimed at curbing discrimination against HIV-infected workers, a leading newspaper said on Sunday.

It would cover areas such as recruitment, transfers and promotions, and would be applied first in all state government offices, the Hindustan Times said, quoting Maharashtra's health secretary, Vijay Satbir Singh.

The state would ask private-sector firms to adopt the policy after a few months, the paper said.

"Authorities who know about the HIV-positive status of an employee would be required to keep it confidential," Singh was quoted as saying.

There are an estimated 650,000 HIV-infected people living in Maharashtra, India's wealthiest state. The policy, the first for an Indian state, was likely to be announced on Dec. 1 to coincide with World AIDS Day, the paper said.

India recently overtook South Africa as the country with the highest number of people living with HIV -- an estimated 5.7 million, according to the United Nations.

Although India reported its first case 20 years ago, it has yet to enact a law to prevent discrimination against patients, many of whom face acute stigma at home and in the workplace.

General provisions in the Indian constitution against discrimination only apply to the government, state agencies and the public sector, and not private firms, where much of the hostile treatment of HIV-positive people is reported to occur.

LIBERIA: Stigma blunts AIDS action

By, IRIN PlusNews, November 10, 2006

GANTA, 10 November (PLUSNEWS) - The bustling commercial town of Ganta, a five-hour drive from the Liberian capital, Monrovia, is emblematic of the AIDS challenge facing the country as it rebuilds after 14 years of civil war.

Ganta is the hub of trade and travel with eastern neighbours Guinea and Cote d'Ivoire, sucking in investment and people looking to make quick money. But the factors driving its recovery threaten to undermine its long-term stability. "Everything passes through here; there are visitors every day and the popuation is growing - we do expect an increase in AIDS infection," said Dr Albert Willicor at the United Methodist Hospital, the main health facility in town.

Newly elected President Ellen Johnson Sirleaf is committed to Liberia's recovery and reconstruction, but the challenges are enormous in a country of three million people and an annual budget of just US$129 million.

"The new government is very promising and well-liked here and overseas," said Susan Thomas, field coordinator for Medecins Sans Frontieres (MSF)-Switzerland in Saclepea, 40km from Ganta. "But when you think how much was destroyed during the war ... if you scratch the surface you see you cannot even post a letter."

The war not only stopped effective HIV/AIDS awareness campaigning, but the trauma of the conflict and the aftermath of poverty and joblessness has had a "deep psychological impact", according Rev John Togba, a genial and energetic HIV/AIDS counsellor at the Methodist Hospital.

"Girls are out of school, maybe the only sponsor they had was killed, and they often have no other option but to end up in prostitution," said Togba. "Sometimes it's the parents who push the child out on the streets: 'your friends are bringing home bags of rice, why aren't you?'."

Ganta's Nimba County is one of the main destinations for refugees, still returning three years after Liberia's warlords made peace. "Ninety percent of them are poor; most of them are single women," said Berkone Nagga, protection officer for the UN refugee agency, UNHCR, at Saclepea. "The women lost their men during the war or were divorced. Many of them have nothing except what we give them - it makes them very vulnerable."

It is not that people are unaware of AIDS; everybody IRIN/PlusNews spoke to in Ganta's main market had heard that condoms can prevent HIV infection, and several people mentioned unsterilised medical equipment and mother-to-child transmission as other likely routes for the virus.

The laidback owner of the motel next to Planet 44 - a popular new music bar on the main street, insisted that he handed out condoms to all guests who asked for them. Susan Habbah, who turned heads as she strolled by, said: "I just want to advise my friends on the street, 'stay at home, God will provide.'"

Despite assurances of their personal commitment to safe sex, there was much less conviction on how widespread condom use was among others. "Liberians like skin-to-skin, flesh-to-flesh," was a cliché that cropped up in most conversations on the issue. Apart from an antipathy to latex, there was the more practical problem of availability - neither of the two pharmacies visited had any on the shelves.

Sempti Menown, a young and opinionated motorbike taxi-driver, underlined clearly that awareness was not synonymous with acceptance. Describing HIV/AIDS as a "false religion", he added: "I need to be convinced that AIDS exists; people need to show me somebody with it."

The problem is that he is far from alone in his denial. For community radio journalist Pauline Biddle, AIDS was something that happened elsewhere, not in Ganta. It was only when she heard an HIV treatment programme was about to start at the Methodist Hospital under Dr Willicor's supervision that it dawned on her that "AIDS is here".

At the moment Liberia has no national HIV prevalence figure. Among health workers the estimates for HIV infection vary between 5 percent and 10 percent, but all agree that the stigma attached to AIDS will stoke the epidemic unless addressed.

"There's a lot of fear and a lack of knowledge," said MSF's Thomas. "We're at the very early stages of HIV intervention, we're starting from the very bottom."

Togba said 25 of his patients had been diagnosed as HIV positive since March - roughly four a month - most of them having lived at some stage in Cote d'Ivoire or Guinea. They did not come for testing voluntarily, but were identified through blood screening or clinical signs. "There is a problem of confidentiality, that is what people are really concerned about - confidentiality and stigma."

For close to a year Dr Willicor has been preparing for the launch of a treatment programme at the Methodist Hospital. In October he took delivery of the first consignment of antiretroviral drugs from the National AIDS Control Programme, but the initiative was delayed when the first patient selected for therapy pulled out.

"She was so enthusiastic - I had told her it was free; it would be confidential," he said, shaking his head.

"What's needed is more education, done with patience, and it has to be persistent," said Togba, who started counselling only in 2005. "The schools have to be involved and the churches too, and we also need visual AIDS: talking is effective, but seeing is more effective."

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INDIA: New study reveals HIV/AIDS stigma in hospitals

By, IRIN PlusNews, October 24, 2006

India's growing HIV/AIDS pandemic is putting more pressure on hospitals to provide improved levels of care, but prejudice among medical staff against HIV-positive people is keeping those most in need away, according to a recent report.

'Reducing AIDS-related Stigma and Discrimination in Indian Hospitals', is being viewed with interest by policy makers and practitioners in India, as stigma and discrimination against people living with the virus threaten to derail official efforts to contain the epidemic.

The study was conducted by HORIZONS, a global research programme affiliated with the Population Council, a US-based reproductive health nongovernmental organisation (NGO), in conjunction with SHARAN, an Indian NGO, and the Delhi-based Institute of Economic Growth.

Researchers spoke to doctors, nurses, hospital administrators, managers and people living with HIV and AIDS and their caregivers at one private and two state-owned hospitals in the capital, New Delhi, between 2002 and 2004.

In one interview, a doctor is quoted as saying, "High-risk population means lower class people - they live in slums, in unhygienic conditions; they sleep with anybody and everybody, extramarital affairs are common, and also drug users and sex workers come into this category." Another doctor commented, "There is a separate bed which is earmarked for an HIV-positive patient, and I see to it that it is not used by any other patients."

Several people living with HIV and AIDS who participated in the study said their common experience was denial of care, delay in treatment and multiple referrals.

"The doctor refused to examine me for almost two months - he even stopped doing my dressing. He just told me to continue with my medicines. He also referred me to another hospital for an operation that he would not do, as it would be too costly for me," one HIV-positive respondent told the researchers.

There were mixed reactions among staff regarding counselling and testing practices. Nurses at one hospital said mandatory testing was carried out, especially for those requiring surgery or invasive procedures, but doctors did not ask for consent and the patient was not provided with professional counselling, as there was no trained HIV/AIDS counsellor in the hospital. They commented that many patients would not have been able to understand the form, or would have refused to be tested if they had been asked.

Much of the discrimination was due to inherent prejudices against those infected with HIV, but the difference in treatment given to people living with the virus also stemmed from a lack of knowledge and inadequate institutional support for infection control.

Although the infection control committees in each of the hospitals had guidelines, and the staff had undergone training, their knowledge was often outdated.

"New knowledge about safeguarding staff was not always shared with all staff members. For example, the staff interviewed had low awareness about post-exposure prophylaxis (PEP) and its potential to reduce the risk of infection following potential exposure to HIV. Most of the staff interviewed were not aware if PEP was available in their hospital or how to access it," the report said.

The findings have raised concerns about patients being tested for the HI virus without giving informed consent.
"Guidelines by NACO [National AIDS Control Organisation] are clear. Doctors have to explain the issues to a person before he/she can be tested for HIV. Testing cannot be done unless he/she agrees," said Arti Malik, advocacy officer at the Lawyer's Collective HIV/AIDS Unit, an Indian legal aid group.

Malik pointed out that fear prevented more instances of hospital discrimination against HIV-positive people from coming to light. "We are willing to take up the cases, but not too many HIV-positive people are willing to take a government institution to court on grounds of stigma and discrimination. We have much anecdotal evidence, such as a recent case of an HIV-positive pregnant woman who was denied a bed in a government hospital in Delhi and who slept on the floor. The child died but the woman did not file a case. Instead, she went back to her village."

The findings were also used in pilot approaches to motivating hospitals to become more caring towards HIV-infected people. For example, a PLHA-friendly Checklist' (people living with HIV and AIDS) was developed as a self-assessment tool for hospital managers to identify institutional strengths and weaknesses in services for HIV-positive people, and evaluate hospital policies and procedures to protect staff from the risk of exposure to HIV. Hospitals were then assisted to develop 'action plans' to improve the situation.

After the pilot intervention, "doctors were more likely to agree that patients should not be tested for HIV without their consent. They also were more likely to seek informed consent ... [when] they ordered an HIV test" the report noted. After the pilot project a greater proportion of doctors and nurses said HIV-positive individuals had the right to decide who should know their status, but this was not the case among ward staff.

HORIZON's Vaishali Mahendra hoped the findings would have a significant impact in public hospitals. India's National AIDS Control Organisation, for example, has endorsed the PLHA-friendly Checklist to be used in all public hospitals, and the report has been disseminated to all the State AIDS Control Societies in the country.

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Source: http://www.irinnews.org/AIDSReport.ASP?ReportID=6481&SelectRegion=Asia&SelectCountry=INDIA