HIV/AIDS Related Stigma and Discrimination among Health Providers and High Officials: The Need for an Advocacy Strategy to Change Attitude

Khalid Hasan, ORG-MARG Quest

Background: This article discusses the stigma and discrimination along with its prevalence and effects in the context of HIV/AIDS among the health providers and high level officials in Bangladesh. People with AIDS are stigmatized and looked at negatively by other people and often discriminated against. HIV/AIDS-related stigma and discrimination poses a serious challenge to the effectiveness of AIDS prevention and care programs. To address this concern, OMQ/AC Nielsen Bangladesh conducted a study on HIV/AIDS related stigma and discrimination in Bangladesh. Methodology: The study was qualitative in nature and was conducted among health providers such as doctors and nurses attached to different hospitals as well as high level government officials who are involved in the policy and decision making process. The study was conducted in January 2002. Findings: It is found that the HIV/AIDS related stigma and discrimination seriously exists among the doctors and nurses in Bangladesh. The employers of health clinics and health workers exhibit fear due to the stigma they feel towards those infected with HIV. It was also found that the top-level executives (i.e. policy makers), in general, are not aware about the current HIV/AIDS related stigma and discrimination that exists among the doctors and nurses. The doctors and nurses were asked to mention whether they would be willing to provide treatment to these categories of patients if they were to come to the hospital and seek treatment as an AIDS patient instead. The initial reaction of the respondents was of somewhat surprise and shock. Apparently, most of them were not happy to be asked whether they would be comfortable treating AIDS patients. It may be mentioned that when asked to prioritize the patients of different profiles (such as professors, judges, family members, traders, CSW, MSM etc.), the doctors and other hospital staff became uncomfortable and were slightly reluctant to list and prioritize. However, after further probing they finally responded and the following information was compiled from their responses. As a whole, it was found that respondents would be willing to treat their colleagues and other hospital staff before they treat anyone else. Furthermore, they would be willing to treat high profile respondents first such as professors, judges followed by family oriented members and then high risk groups such as truck drivers, footpath traders, road sweepers, laborers working abroad, female drug users, CSWs, MSM etc. It is also revealed from in-depth interviews and focus group discussions of the study, that although the government officials have the decision making power at state-level, they in fact have inadequate level of knowledge in terms of AIDS awareness. However, almost all of the doctors and nurses agreed the presence of stigma and discrimination at all levels, including hospitals. Discussions: Stigma and discrimination also extends its reach to people associated with HIV-positive people such as health providers, hospital staff, as well as family and friends. Such discrimination may have arisen from the fact that early HIV prevention programs related HIV with so-called “illegal behaviors”, such as sex outside marriage and intravenous drug use, as well as with death and dying. This poses as a barrier for HIV-positive people in disclosing their illness and getting access to support and care services. Suggestions: Misconceptions about HIV/AIDS and related stigma and discrimination can be overcome if the media acts as a tool for bridging this knowledge gap. Most importantly, there is an immediate need for an HIV/AIDS advocacy strategy, especially on stigma and discrimination. Reducing stigma and discrimination requires: 1) developing positive HIV prevention messages; 2) recognizing the diversity of sexual behavior; 3) encouraging HIV-support groups; and 4) providing quality counseling. Moreover, a comprehensive public-private partnership should be enforced to ensure initiative from all sectors. Likewise, behavior change communication program should be enforced for the target groups, such as doctors, nurses and other hospital staff. The strategy should also focus the high level officials involved with decision-making processes. However, with a view to reduce, if not eliminate, stigma and discrimination, following steps should be taken toward changing the behavior- § Immediate development of an advocacy strategy for the decision makers and health providers § Increasing awareness of the top level decision makers in both public and private sectors § Enforcing public-private partnership § Behavior change communication for the targeted population. The high level of stigma and discrimination due to HIV/AIDS in Bangladesh is a hindrance to successful prevention activities; care and support of those infected and affected. In breaking the silence and changing attitude, high level government officials have to be in the forefront advocating laws and policies that safeguard youth, women, and children from this deadly disease and ensure their right to healthcare. Organizations working on health consumers rights should come forward to safe guard the rights of the people living with HIV/AIDS. Author: Khalid Hasan PhD, Country Director, OMQ/AC Nielsen Bangladesh, Dhaka, Bangladesh. House # 70, Road # 15A, Dhanmondi R/A, Dhaka 1209, Bangladesh; Email: hasank@dhaka.agni.com