C. Maya

Thiruvananthapuram: There is an urgent need to improve knowledge levels of doctors and other health care providers on HIV/AIDS infection, its modes of transmission and the universal precautions to be adopted in hospitals to reduce the stigma and discrimination faced by HIV-positive persons.

Gaps in information among doctors and paramedical staff about HIV transmission and the fear of infection at workplace encourage many to deny care to HIV-positive people. On the other hand, the stigma and discrimination they face in hospitals discourage HIV-positive persons from revealing their positive status.

However, an initiative by the Kerala State AIDS Control Society (KSACS) and Engender Health India, an NGO, has proved that a rights-based approach, which protects the rights of HIV-positive persons while at the same time addressing the fears and concerns of health care providers, is necessary.

The one-year project, which began in April 2006, was funded by the UK Department for International Development (DFID). It focussed on the health sector as a critical entry point for promoting and protecting the rights of those living with HIV/AIDS in Kerala.

The project concentrated on increasing awareness of HIV and related issues among health care professionals and other stakeholders through communication and training programmes. Selected public and private hospitals in three districts with high HIV prevalence in the State Thiruvananthapuram, Palakkad and Kozhikode were chosen for project implementation.

"The knowledge levels about HIV was extremely poor, especially among the paramedical staff in private hospitals, who found it easier to refer the HIV-infected to Government hospitals. The staff in Government hospitals on the other hand were forced to provide care, but resented it, which meant that the quality of care was poor," says Gikson Jose, the project manager. "Often hospitals resort to mandatory testing for HIV, without obtaining informed consent and pre-test counselling is unheard of. Those found to be HIV-positive are then denied care or referred to some Government facility," Mr. Jose pointed out. In the words of an HIV-positive person, "they handed me the dressing and asked me to do it (dressing the wound) myself." Health care providers on the other hand pointed out that "we cannot approach an HIV-positive person as a normal patient. We deal with their blood and blood products." The project identified that health workers had poor knowledge of standard precautions. Training and information on HIV-infection and precautions was restricted mostly to doctors, resulting in the lower-level staff often denying care to the HIV-infected. "Our subsequent interactions with health providers found a marked change in their attitude towards HIV-positive persons. Also, they had implemented standard precaution processes. We are now looking to scale up this initiative across the State," a KSACS official said.

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