Stigma in healthcare settings - A consultation with care providers
Pushpraj Dalal, Kumar Nishant
“Normally we don’t do anything discriminatory with
HIV+ cases, but yes once they leave we discard their
sheets and other things and in some cases just burn
them” Said a nurse working at a Delhi hospital, who
was one of the many we spoke to during our research.
What does not come out from her statement is that she
does this to protect other non-HIV patients from getting
infected. This may be a case of ‘misguided nurturing’,
but data tells us that we are looking at something much
bigger and deep rooted in society, answers of which
can’t be defined just in black and white.A United
Nations Development Program (UNDP) study on the
socio-economic impact of HIV reveals that 67% of
health providers feel that clothes and linen should be
destroyed after HIV positive patients used them. Also as
per another research by Pop Council 55% agreed that
HIV+ patients should be distanced from other patients.
India has made remarkable efforts in curbing the
prevalence of HIV in the country spear headed by the
Department of AIDS Control Organization (NACO) for
more than two decades. But it is not denied that from the
2.1 million HIV+ people in India, many are stigmatized
and get discriminated in the different walks of life. In a
hospital setting we see such behaviour in the form of
delay in appointment/treatment, referral and re-referral,
labelling of beds, isolation of wards, verbal abuse etc.
Dr. B.B.Rewari National Program Officer (ART),
NACO points out “there is still denial of services to
PLHIV in many healthcare settings; though such
instances have reduced they have not completely
stopped. It is time that we make them go away”.
When Improving Healthy Behaviour Program (IHBP)
began work to develop a campaign to address this issue,
we tried to understand the possible reasons(s) for
PLHIV facing stigma at healthcare settings and found
that, though knowledge and awareness of HIV is
present, the primary emotion that overwhelms
healthcare providers while treating HIV+ patients is
fear. Proper awareness of HIV however, is still not
consistent among support staff like nurses, ward boys
and paramedics. Dr. Sameer Kalra, a practicing doctor
in Delhi’s Gangaram hospital has to say “At the
peripheral levels of a hospital (nurses, ward boys,
paramedics), there is lack of awareness which also
causes fear” Dr. Meghana Kabra, a practicing doctor at
Batra Hospital agrees “There is a high attrition among
the frontline staff. Thus one needs to have awareness
programs and trainings at hospitals on a continuous
basis”.
When treating HIV patients, especially cases where
there is a chance of being in contact with body fluids, it
is important to acknowledge at this point that healthcare
providers genuinely stand at risk. This risk however can
be minimized to a great extent by the use of Universal
Precautions and in case of any accidental prick or injury
while treating HIV patients there is Post Exposure
Prophylaxis ( PEP) which can help limit the spread of
infection. It is interesting to that using Universal
Precautions for treating any patient is a standard
guideline and is not only to be used while treating HIV
patients. Universal Precautions thus should be a way of
life, using it in all medical cases. Mr. VK Subburaj,
Secretary, NACO mentioned “Stigma among PLHIV
was earlier seen primarily at school and work setting
where children of HIV+ people were denied admission
and those diagnosed with HIV were refused
employment. These two issues have been effectively
addressed through intensive awareness campaigns.
NACO has taken significant measures to reduce stigma
faced at hospital settings, an exclusive campaign on the
issue can generate great momentum for change”. Most
importantly, we feel such a change can be brought when
doctors all over acknowledge the issue and commit to
take corrective steps to address it. A doctor is a key
influencer in healthcare setting and any resolve or action
taken by a doctor has a great impact on rest of the
hospital staff. It’s also important that doctors do not
forget the ethics of medical profession and practice
equal care i.e. treat all their patients regardless of age,
gender and disease. Doctors also need to discuss their
learning and share inspirational stories of equal care to
inspire people around them. NACO and IHBP’s
initiative, www.heroesinwhite.com is such a platform
for them to come together. As rightly mentioned by Dr.
AK Gadpayle, HOD, Ram Manohar Lohiya Hospital in
Delhi… “There is PEP for any transmission risk, but the
greatest thing that doctors should have is compassion.
Just listening to the patient gives him half of the relief.
A doctor who would discriminate between patients is
not a real doctor” For more information of NACO’s campaign
on stigma and discrimination, log on to www.heroesinwhite.com
The authors are working with the IHBP project of FHI360 that provides
technical assistance to Ministry of Health and Family Welfare
(MOHFW) and Department of AIDS Control, India to develop
evidence based communication campaigns.