Sensitization of rural health workers on HIV/ AIDS

[Guest guest]

Dear Forum,

 

I would like to share the findings from a qualitative assessment that we have

conducted among grass root level health care workers, as part of HIV/AIDS

programs conducted by our organization earlier this year. 

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Need for sensitization of health workers to address stigma and discrimination in

rural health care settings

 

A major challenge in rural India continues to be the stigma associated with HIV/

AIDS.  Rural health care workers, at the forefront of providing care to HIV

affected, have considerable misconceptions and stigma on HIV / AIDS.  In rural

health care settings this often leads to discriminatory and unfair practices

against those affected by HIV.

 

Village health nurses (VHNs) working in Maduranthakam Taluk participated in a

series of workshops conducted by Kalanjiyam in January 2010.

The workshop objectives were to address gaps in knowledge, misconceptions and

stigma associated with HIV/ AIDS while at the same time try to better understand

practices while dealing with HIV positive persons in rural health centers.

Prior to discussions, all VHNs completed an objective instrument with questions

related to their views, stigma and current practices in rural health centers.

 

Awareness on HIV/ AIDS

The participating VHNs reported that awareness on HIV/ AIDS was high among rural

health workers.  When probed in-depth many VHNs were unable to clearly

distinguish differences between HIV and AIDS.

Most of them believed they could distinguish a person with HIV, by looking at

the appearance, based on factors such as how weak the person looked, extent of

hair fall, presence of mouth sores, extreme thinness, frequency of diarrhea and

fevers and in general poor resistance to other illnesses.

Though VHNs aware about treatment availability they were unable to articulate

about ART or explain about the treatment process for pregnant women.  About one

third of participating VHNs had treated a HIV positive person.

 

Stigma associated with HIV/ AIDS

We asked the VHNs a series of questions to determine the level of stigma

associated with HIV/ AIDS.  Over 90% of VHNs expressed willingness to eat with

HIV positive person, buy food from a HIV positive food seller, visit a HIV

positive neighbor’s house, and work with HIV positive co-worker.

However 80% of the VHNs thought that HIV resulted from immoral behavior and 26%

felt that children of HIV positive parents should be separated from them.

About 63% agreed that only women who practiced sex work should be worried about

HIV and 32% felt that a positive woman had only herself to blame for getting

infected. 

 

Perceptions of risky and prevailing practices

While touching or eating with HIV positive person was considered low risk, VHNs

associated cleaning the wound or delivering child of a HIV positive person as

high risk tasks.

VHNs were well aware of pre and post counseling process, yet many reported that

HIV testing was done without knowledge or informed consent of patients.  They

strongly agreed that HIV infected persons have right to same care and treatment

as other patients; yet they reported that this was not the common practice. They

reported that HIV positive persons in hospitals are segregated from other

patients; positive persons in poor health conditions are not admitted into the

hospital; or positive persons requiring surgery are refused.

A common practice reported was the routine informing of partners or family

members about the HIV status of tested person. 

 

Recommendations

Regular and sustained interventions are required with all tiers of rural health

care workers to effectively address knowledge gaps and misconceptions on HIV/

AIDS.  In such interventions it is critical to include sensitization on gender,

sex and sexuality to effectively address the stigma associated with HIV. Further

sensitization on rights of positive persons is very much required to prevent

discriminatory practices in rural health care settings.

Munusamy Raviraaj

Founder & Director, Kalanjiyam Trust

email: raviraaj@... / kalanjiyam@...