ICTC Team Training 1 Understanding Stigma and Discrimination

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Understanding Stigma and Discrimination

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We often view AIDS as something that can affect other people, people who are different from us, people who lead perverted or sinful lives.

From here it is a short step to blaming People with AIDS for their own condition.

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Stigma

“Setting aside certain persons or groups from the normal social order because they have some negative characteristic.”

We devalue them We do this because we believe they are very different from us

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Discrimination

“The unfair and unjust treatment of an individual based on his or her real or perceived HIV status.”

When we set aside people or stigmatise them, it is easier to treat them differently. If a person feels stigma towards another, she /he can decide to not act in a way that is unfair or discriminatory.

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OPEN DISCRIMINATION HIDDEN DISCRIMINATION

Refusal to provide treatment for HIV/AIDS-related illnessRefusal to admit for hospital care/treatmentRefusal to operate or assist in clinical proceduresRestricted access to facilities like toilets and common eating and drinking utensilsPhysical isolation in the ward (e.g. separate arrangements for a bed outside the ward in a gallery or corridor)Stopping ongoing treatmentEarly discharge from hospitalMandatory testing for HIV before surgery and during pregnancyRestrictions on movement around the ward or roomUnnecessary use of protective gear (gowns, masks, etc.) by health care staffRefusal to lift or touch the dead body of an HIV-positive personUse of plastic sheeting to wrap the dead bodyReluctance to provide transport for the body

Delays in treatment; slow service (e.g. made to wait in queues, asked to come again)Excuses or explanations given for non-admission (but admission not directly refused)Shunting patient between wards/doctors/hospitalsKeeping patient under observation without any treatment planPostponed treatment or operationsUnnecessarily repeated HIV tests Conditional treatment (e.g. only on the condition that the patient will come for follow up or join a drug trial programme).

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Informed Consent for HIV Testing

The client agrees to HIV testing through giving his/ her informed consent.

Informed consent is a deliberate and autonomous permission given by a client to a health-care provider to proceed with the proposed HIV test procedure. This permission is based on adequate understanding of the advantages, risks, potential consequences and implications of an HIV test result, which could be both positive and negative.

This permission is entirely the choice of the client and can never be implied or presumed.

(From ICTC Operational Guidelines)

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Discussion Question

If mandatory testing for HIV before surgery and during pregnancy is described here as a discriminatory practice, then what about provider-initiated testing and counselling?

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Continuum between Care and Prevention

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Continuum between Care and Prevention – Effect of Stigma

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Why do we stigmatise and discriminate?

Lack of awareness of how stigma affects People Living with HIV/AIDS

Fear of human beings of being infected from ordinary contact with people already infected with HIV

Associating people with HIV with behaviours that are immoral


Universal Safety Precautions

Risk reduction measure at the workplace. Practising Universal Safety Precautions

means applying blood and body-fluid precautions universally to all persons regardless of their presumed infectious status.



Staff working in the blood collection room and laboratory should observe the following precautions:Using gloves when handling blood samplesUsing disposable needles and syringes for drawing bloodPractising routine hand-washing before and after any contact with blood samplesDisposing of sharp instruments safely as per procedure, e.g., discard disposable syringes in a puncture-resistant container after disinfection with bleach solution



Disinfection and sterilisation Kits for safe delivery of HIV-positive pregnant

female patients Waste management



Post Exposure Prophylaxis (PEP)

Comprehensive medical management to minimise the risk of infection among HCP following potential exposure to blood-borne pathogens (HIV, HBV, HCV).

Includes counselling, risk assessment, relevant laboratory investigations, first aid and provision of antiretroviral drugs.

NACO Policy on Post Exposure Prophylaxis (PEP)

Step 1: First aid in management of exposure

– For skin– For the eye– For the mouth

Step 2: Establish eligibility for PEP

– First PEP dose within 72 hours

– Assessing risk of transmission

– Assess exposed individual

Step 3: Counselling for PEP– Psychological support– Document exposure

Step 4: Prescribe PEP

Step 5: HIV chemoprophylaxis

Step 6: Follow-up of an exposed person

– Clinical follow-up– Laboratory follow-up


Documents

ICTC Team Training 1 Understanding Stigma and Discrimination