Health Care Discrimination in HIV Care

doi:10.4236/wja.2011.13015

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World Journal of AIDS, 2011, 1, 100-103

doi:10.4236/wja.2011.13015 Published Online September 2011 (http://www.SciRP.org/journal/wja)

Health Care Discrimination in HIV Care

Jayakumar Palanisamy1, Senthilkumar Subramanian2

1Primary Health Center, Periyapothu, Pollachi, Coimbatore, India; 2Department of Public Health and Preventive Medicine, Coimba-

tore, India.

Email: [email protected]

Received July 21st, 2011; revised August 14th, 2011; accepted August 26th, 2011.

ABSTRACT

Human Immunodeficiency Virus (HIV) infected population is experiencing enormous amount of social discrimination

and stigmatization compared to other patients with any other chronic illness. Healthcare setup is not an exception

where the HIV infected patients are shuttled from one place to another to get their basic services compared to HIV

negative patients. This referral game of manipulation imparts additional stress to the already stressed HIV infected

population. The physica l and psychological impacts caused b y other chronic conditions will be supplemen ted by social

impact in the HIV infected population. Th is referral game in healthcare can cause the HIV infected to avoid their health

seeking behavior and it may bring them back to their high risk activities, which can result in higher mortality/morbidity

and failure in prevention and in tervention strategies.

Keywords: HI V , AIDS, Discrimination, Healthcare

1. Introduction

HIV (Human Immunodeficiency Virus) infection and its

social impacts stigma/discrimination are always traveling

together like a train track. With education stigma/dis-

crimination in the society coming down but still the

changes are not up to the mark. The situation is same for

the health care setting too [1,3-9]. In this review article

the social impacts of stigma and discrimination in the

healthcare setting are tried to get explored and the net

effect is hypothesized.

2. Hypothesis

2.1. The Discrimination and Referral Game

Even though the healthcare professionals are ready to

treat HIV patients along with other diseases with their

improved knowledge and newer development, the dis-

criminatory behavior while treating HIV patients still

exists [1-6].

Patients coming to the outpatient department for

medical or surgical problem may be referred for HIV

screening [6] to Integrated Counseling and Testing Cen-

ter (ICTC) and if the patient is found to be positive for

HIV then they will be referred to Antiretroviral Therapy

(ART) Centre, where the client is going to stay for their

remaining lifetime.

When HIV patients are referred to other medical or

surgical specialties, they are less likely to be treated/ad-

mitted in respective departments as inpatients [5-7]. Most

often the referred departments refer back the patients

with the advice of conservative management, even for

the genuine cases which need an intensive specialized

management. Few cases which get admitted are managed

by case sheet entries not the clinical management. These

patients are also segregated in the wards.{Example: A

meningoencephalitis patient is getting Ryle’s tube feed-

ing and intravenous(IV) antibiotics as per case records

but in the ward that patient is neither on Ryle’s tube nor

on IV line}.

2.2. Tyndal Effect to Pinball Effect

Here we explain the above mentioned referral game by

combining the physics of Tindal effect (When the ray of

light hit the particle in a media, the ligh t ray get dev iated)

and the ball game Pinball (Manipulation by hitting the

ball away in a closed playfield).

When a person is found to be HIV positive he/sh e may

gain entrance into the playfield of health system. The

positive person is referred from one department to an-

other department particularly when they are critically ill

and need specialist care which is comparable with the

manipulation of pinball to score more. Most of the times

healthcare professionals are not ready to admit or treat

HIV infected patients. This manipulation of referral

Health Care Discrimination in HIV Care101

game results in unnecessary stress to the already stressed

HIV positive clients. The end of the game will be the

positive person gets frustrated and gets out of the play-

field of health system by not seeking medical attention at

all or may die or may get back to their HIV Physician

(Figure 1).

Examples: 1) When a patient is referred from ART

centre to medical department for meningoencephalitis,

the medicine department people refers that case to neu-

rology department, but the neurologist refers that case to

the Sexually Transmitted Diseases (STD) ward and vice

versa, at the end treatment is denied by this referral game.

2) Surgeons may advice medical management where

pure surgical intervention is indicated.Intradepartmental

discrimination of People living with HIV and AIDS

(PLHA) also possible with difference in knowledge, fear

of infectivity and discriminating behavior among differ-

ent HealthCare Workers (HCW’s).

3. Discussion

In addition to the depression and psychological distur-

bances caused by diagnosis of HIV [12-14]. The referral

game adds the stress to the already stressed. The above

explained overwhelming psychosocial stressors could

result in rapid disease progression following deprived

immunological status. Reasons given by most studies for

stigma and discrimination in hospitals among health care

workers (HCW) include lack of training, education,

anxiety regarding infectivity, etc [1,2,8-11].

Stigmatizing/ Discriminatory behavior may be high in

developing countries but it exist in developed countries

too [1-11]. The Stigmatizing/Discriminatory behavior

includes adopting Universal precaution (UP) measures

only against PLHAs, fear of infectivity, burn ing linens of

PLHAs, informing HIV status to family members with-

out the consent of PLHA, isolating them in wards, post-

poned/changed treatment with identification of infective

status, refusing treatment and charging PLHA for cost of

infection control, etc [6,7]. Many developing country

HCWs believe that PLHAs behaved immorally and de-

serve the disease and also showed their desire for sepa-

rate ward to treat PLHA [2,7].

Following Universal precaution is an important meas-

ure in reducing the stigma/discrimination. Differing de-

gree of knowledge in using Universal precaution, fear of

infectivity, discriminatory behavior and willingness to

treat PLHAs noted among HCWs worldwide [20]. HCW

adopting Universal precaution against PLHAs only,

shows discriminatory behavior and fear of infectivity,

which is seen in both developed and developing coun-

tries [20,25]. Poor adherence with universal precaution

practices is high with developing country HCWs as

compared to developed countries [20]. Poor UP practices

attributed to lack of knowledg e, availability of materials,

inadequate staffing, long working hours, absence of sus-

tainable educational program, insufficient water supply,

emergency nature of procedure, patient perceived to be at

low risk of Blood Borne Pathogens (BBPs), pressure of

time and UP equipment interference with tech nical skills

by most studies [7,16,20-23].

Universal precaution knowledge was high for both

doctors and nurses but doctors’ practice better UP meas-

HIVCare

Surgery

Medicine

ST D

Opthal

Thoracic

Others

SourceEntry

Tyndal PhenomenonPinballphenomenon

End

Start

HIVCAREINHEALTHCARE

Start Entry

Exit/Death

HealthcareSystem

Figure 1. HIV infected patients are undergoing referral game which starts as a Tyndal effect and ends with death or not

seeking medical care of the client because of discrimination in healthcare setting which can be compared with Pinball Game.

Health Care Discrimination in HIV Care

102

ures compared to nurses except hand washing practices

where nurses are better [20,22]. There is no difference in

knowledge and discriminatory attitude with doctors/nur-

ses [8,21]. Some studies show incomplete knowledge

among nurses but even a perceived knowledge has weak

effect on compliance with UP and willingness to care

BBP infected [18,19]. High risk perception was noted

with doctors and poor knowledge of UP and Post Expo-

sure Prophylaxis (PEP) was noted with surgical trainee

[15,17].

Some studies notified least discriminatory behavior

with physician compared to nurses and the same is high

with servants [1,2], which may reflect knowledge and

educational influence on HCW towards attitude with

PLHAs. Provider not adopting UP and inadequate train-

ing are more likely to favor restrictive policies towards

PLHA [7]. Discriminatory attitud e and fear of infectivity

among HCWs decreases as contact with PLHAs/Homo-

sexuals increased [9]. Adequate UP training improves the

knowledge, adherence and supplies of UP in hospitals

[24].

Various studies done across the world so far have

proven that the mindset of HCWs regarding the immoral

behavior of PLHAs, the lacunae in adopting UP meas-

ures and lack of knowledge are mainly responsible for

the discriminatory behavior among HCWs towards PLHAs.

4. Conclusions

After the decades of HIV identification contact with

PLHAs over the time might made HCWs sensitized and

involved in caring PLHAs. Varying degr ee of knowledge

among professionals and countries should be tackled

with targeting multidisciplinary approach by providing

knowledge with training, workshop and creating profes-

sional/social models to interact.

To improve the care of the HIV infected the referral

game should be demolished. So training for all healthcare

professionals is necessary regardless of their branch in

medicine. The hypothesized referral game should be ex-

plored by further studies to improve the care in HIV in-

fected clients.

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