[afro-nets] AIDS in Nigeria and health care

[Tunde <nigeriaaidsdoc@yahoo.co.uk>]

AIDS in Nigeria and health care
-------------------------------

A recent NGO & POLICY study in Nigeria which was presented in a
number of workshops last year and quoted in part in a UNAIDS up-
date, (Dec 2003) showed that some health professionals in Nige-
ria have refused to treat people with HIV. The following is
based on what was handed out in the workshops

9% of doctors and nurses who were interviewed said they refused
to care for and/or admit PLWA 66% and 43% of health profession-
als reported witnessing a colleague do this respectively. This
study concluded that these discriminatory behaviors and atti-
tudes can be addressed in several ways including improvement of
training of health care professionals on HIV and AIDS and pro-
viding sufficient materials for prevention, treatment and care.

The study findings also provide information on misconceptions
regarding appropriate treatment and care for PLWA. Fear of be-
coming infected appears to be a major concern among health pro-
fessionals, and is likely to be responsible for discriminatory
attitudes and behaviors among many professionals. Another common
perception among health practitioners is that treatment of
HIV/AIDS and related condition is a waste of precious resources.

The study found that testing patients without informed consent
appears to be common practice, and is generally performed with-
out any counseling of the individual regarding how they can pro-
tect themselves from infection, and if infected, protect others
from infection and live healthy lives with HIV.

About half of health care professionals reported that routine
HIV testing of all patients scheduled for surgery always took
place and 50% reported routine HIV testing of all women attend-
ing antenatal care clinics. 78% agreed that there are circum-
stances where it is appropriate to test a patient for HIV with-
out his knowledge or consent. The study also interviewed some
PLWA who had bad experiences with such testing.

More than half of health professionals agreed that a person with
HIV/AIDS cannot be treated effectively in their facility. 12%
said that treatment of opportunistic infections in HIV/AIDS pa-
tients wastes resources, and 8% agreed that treating someone
with HIV/AIDS is a waste of precious resources.

Among health care professionals, the three most important con-
cerns about treating HIV/AIDS patients were fear of becoming
contaminated (81%), contamination of facility, materials or in-
struments (17%), and not having materials needed to treat (10%).
72% reported that universal precautions were always practiced.
Of those not reporting consistent use of universal precautions,
65% cited lack of materials as the reason. 91% agreed that staff
and health care professionals should be informed when a patient
is HIV positive so they can protect themselves.

Some of the PLWA that the study interview said that special and
unnecessary precautions used by medical personnel when they are
seen at a health facility included the use of extra gloves or
protective gear (61%,) charging them more than other patients
(26%), and separating them from other patients (11%). They also
said that the main obstacles faced by PLWA in trying to access
health care are lack of financial means (73%), fear of being
stigmatized (45%), and a lack of knowledge of having the disease
(33%).

11% of PLWA reported being refused medical care. 17% observed
others being refused medical care. 6% were refused admission to
a hospital and 12% saw an HIV+ patient being refused admission
to a hospital. 9% reported that their confidential information
had been given to their family member by medical personnel and
10% observed this happening to another PLWA. 8% said they were
verbally mistreated.

Staff of both private and public facilities reported cases of
PLWA being refused admission but less than 1% reported verbally
mistreating an HIV/AIDS patient and 27% of health professional
respondents reported seeing others verbally mistreat HIV/AIDS
patients. 38% of professionals reported giving confidential in-
formation to a patient's family member without the patient's
consent, and 53% had observed this behavior. These are probably
underestimates because health care professionals are likely to
have not reported their own unethical or discriminatory behav-
ior.

In addition to reporting discriminatory behaviors, health care
professionals held beliefs and attitudes towards PLWA that
likely contributed to discriminatory behavior towards and bad
consequences for PLWA. 40% of professionals reported that it is
possible to determine a person's HIV status by looking at him or
her. Almost 60% agreed that people with HIV/AIDS should be on a
separate ward in a hospital or clinic, and 21% agreed that they
could refuse to treat an HIV/AIDS patient to protect themselves
and their family. 20% stated that many of those who contracted
HIV/AIDS had immoral behavior and deserved the disease and 13%
said that women (not men) are responsible for the transmission
of most heterosexual HIV cases.

One quarter of PLWA agreed that women are responsible for
spreading most heterosexual cases of HIV/AIDS. 16% of PLWA
agreed that a person's HIV status can be determined by his/her
appearance and 9% agreed that many of those who contracted
HIV/AIDS had immoral behavior and deserved the disease.

Most health care professionals in the four states where the
study was conducted appear to be providing care to PLWA and to
complying with their ethical responsibilities despite the lack
of sufficient materials needed for treatment and prevention. A
considerable minority, however, reported engaging in discrimina-
tory and/or unethical behavior including denial of care, refusal
of admission to hospital, testing for HIV without consent and
disclosing confidential medical information without permission.

Such behaviors in Nigeria's health sector have to be addressed
to stop AIDS. Also at stake are the health and well-being of
PLWA and the credibility and integrity of health practitioners
and the health system as a whole. There are numerous challenges
to dealing with HIV/AIDS in Nigeria effectively. Many health
care professionals and policymakers are working actively to
overcome obstacles but this study demonstrates that there is
still alot of work to do.

This is likely to be a problem in other places outside of Nige-
ria and I would like to know if anyone else on the list has such
information from their country

--
Tunde
mailto:nigeriaaidsdoc@yahoo.co.uk